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Missouri rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,840.32 / $32,359.37 / $41,686.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151,356.12 / $151,356.12 / $151,356.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,199.52 / $39,810.72 / $64,565.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,782.79 / $35,481.34 / $48,977.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,782.79 / $36,307.81 / $51,286.14