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Virginia rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,311.90 / $51,589.90 / $60,334.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,740.26 / $43,318.53 / $66,406.46
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,741.00 / $52,480.00 / $65,347.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,274.00 / $59,596.46 / $79,318.08