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Idaho rates for MS-DRG 175

Pulmonary embolism w MCC or acute cor pulmonale

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,087.70 / $12,087.70 / $12,087.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36,379.80 / $48,096.60 / $50,246.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,627.25 / $24,444.37 / $28,466.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,108.00 / $17,708.66 / $29,331.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,038.19 / $17,856.80 / $25,847.03