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Pennsylvania rates for MS-DRG 175

Pulmonary embolism w MCC or acute cor pulmonale

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,387.10 / $22,457.00 / $32,433.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,332.00 / $28,248.64 / $38,080.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,912.00 / $20,134.23 / $29,839.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,634.18 / $22,634.18 / $27,484.36
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,942.10 / $22,791.66 / $36,211.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,365.10 / $22,457.00 / $32,095.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,311.60 / $18,543.59 / $29,703.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $11,175.21 / $15,661.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,388.61 / $17,314.23 / $31,405.99