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Pennsylvania rates for MS-DRG 417

Laparoscopic Cholecystectomy Without C.D.E. With Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,842.70 / $39,015.30 / $56,379.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,400.00 / $44,074.71 / $60,724.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,668.61 / $34,979.85 / $50,305.31
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,323.10 / $39,323.10 / $47,749.48
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,429.87 / $35,041.76 / $51,521.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,520.60 / $39,015.30 / $53,569.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,443.41 / $32,216.40 / $50,096.62
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $18,375.16 / $26,413.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,099.15 / $29,841.93 / $54,562.65