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Virginia 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
$60,798.30 / $94,158.10 / $106,506.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67,276.14 / $102,018.78 / $145,422.93
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,832.00 / $20,832.00 / $20,832.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,274.00 / $108,770.94 / $144,765.35