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Utah 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
$41,758.90 / $53,837.70 / $63,676.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,987.05 / $72,773.28 / $87,387.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $28,478.20