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Utah rates for MS-DRG 176

Pulmonary embolism w/o MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,294.20 / $14,561.00 / $19,632.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,896.78 / $19,682.33 / $23,195.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,190.61 / $11,008.78 / $16,502.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $7,702.24