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Pennsylvania rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,243.00 / $48,661.20 / $68,385.80
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,459.92 / $8,459.92 / $8,639.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,049.45 / $46,431.84 / $72,043.75
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49,045.12 / $49,045.12 / $59,554.79
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,486.95 / $56,949.39 / $93,844.88
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,841.20 / $48,661.20 / $66,451.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,510.65 / $43,544.73 / $64,686.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,843.24 / $40,982.05 / $68,052.41