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New Mexico rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,882.00 / $49,881.20 / $69,004.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,774.63 / $25,940.81 / $48,116.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,774.63 / $25,940.81 / $48,116.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,419.00 / $33,201.74 / $51,479.81