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New Hampshire rates for MS-DRG 017

Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosis Pulmonary Embolism

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,812.79 / $59,958.66 / $130,797.95
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55,834.41 / $78,534.75 / $123,697.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63,959.90 / $63,959.90 / $111,307.83