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Hawaii rates for MS-DRG 175

Pulmonary embolism w MCC or acute cor pulmonale

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,594.00 / $3,594.00 / $3,594.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36,212.22 / $36,212.22 / $36,212.22
HMSA
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,720.00 / $30,053.00 / $34,996.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $3,775.00