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Washington 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
$84,363.60 / $134,558.00 / $236,957.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31,732.85 / $116,615.58 / $187,716.49
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58,920.55 / $80,119.05 / $92,922.58
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,995.79 / $112,435.33 / $177,477.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89,078.52 / $119,076.24 / $162,042.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $84,282.13 / $219,557.27