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Indiana rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,427.40 / $55,450.30 / $74,410.00
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,223.51 / $38,223.51 / $38,223.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,448.36 / $44,646.00 / $102,391.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,588.60 / $43,979.29 / $62,302.00