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Pennsylvania rates for MS-DRG 461

Bilateral or multiple major joint procs of lower extremity w MCC

Facilitymedian $89,125 · 10th–90th $50,119–$125,8930%10%10th90th$89,125$2.0K$5.0K$10.0K$20.0K$50.0K$100.0K$200.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $91,201.08 / $128,824.96
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28,840.32 / $91,201.08 / $165,958.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44,668.36 / $83,176.38 / $123,026.88
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97,723.72 / $97,723.72 / $117,489.76
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40,738.03 / $89,125.09 / $107,151.93
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $85,113.80 / $125,892.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42,657.95 / $51,286.14 / $91,201.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,623.41 / $70,794.58 / $128,824.96