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Viral Illness with Major Complications

Pennsylvania rates for MS-DRG 865

Viral Illness with MCC

Rates data updated July 2026.

How much does Viral Illness with Major Complications cost?

$22,387

Typical facility fee. In Pennsylvania, July 2026.

Insurers have agreed to pay about $22,387 for this service. Most negotiated rates run $14,791 to $28,184.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $22,387 · 10th to 90th $12,303 to $33,113
$2.0K$5.0K$10.0K$20.0K$50.0Kfacility $22,387

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$13,803.84
Median
$24,547.09
Typical High
$33,884.42
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$19,054.61
Median
$28,183.83
Typical High
$42,657.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$12,589.25
Median
$23,988.33
Typical High
$31,622.78
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$26,302.68
Median
$26,302.68
Typical High
$32,359.37
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$11,220.18
Median
$24,547.09
Typical High
$31,622.78
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$15,848.93
Median
$30,199.52
Typical High
$46,773.51
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$13,489.63
Median
$22,908.68
Typical High
$33,113.11
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$11,481.54
Median
$13,803.84
Typical High
$23,442.29
United
Setting
Facility
Modifier
Global
Typical Low
$5,623.41
Median
$19,498.45
Typical High
$35,481.34

Where Pennsylvania sits

The same service costs 6.0 times more in Montana than in New Mexico. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Pennsylvania $22,387 · 27th of 51
MT $72,444NM $12,023

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.