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Washington rates for MS-DRG 175

Pulmonary embolism w MCC or acute cor pulmonale

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,908.68 / $33,884.42 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,952.62 / $26,915.35 / $44,668.36
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,054.61 / $26,302.68 / $33,884.42
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,054.61 / $30,199.52 / $43,651.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,892.96 / $28,183.83 / $38,904.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $30,902.95 / $42,657.95