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California rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,697.00 / $31,034.00 / $75,448.80
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,987.00 / $49,346.44 / $84,308.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42,615.00 / $67,876.80 / $105,334.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35,561.72 / $49,994.59 / $97,581.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,693.00 / $46,089.55 / $94,357.83