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Idaho rates for MS-DRG 017

Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosis Pulmonary Embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,804.20 / $47,804.20 / $47,804.20
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87,582.25 / $100,634.38 / $111,538.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,764.00 / $77,966.09 / $129,136.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55,518.11 / $70,619.89 / $102,219.59