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Texas rates for MS-DRG 173

Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,804.00 / $44,687.70 / $67,475.00
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,676.00 / $1,676.00 / $1,676.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.00 / $2,297.00 / $47,968.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,299.40 / $44,241.00 / $78,457.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,281.61 / $37,205.00 / $85,812.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,257.00 / $33,335.68 / $76,213.70