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Illinois rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,308.50 / $37,100.80 / $57,779.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,677.66 / $32,932.41 / $49,342.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,823.11 / $33,416.04 / $59,528.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.58 / $339.52 / $555.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,239.94 / $36,315.06 / $59,766.11