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Wisconsin 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
$81,690.89 / $81,690.89 / $96,819.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65,773.20 / $107,016.50 / $160,090.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59,774.26 / $81,083.87 / $93,972.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59,776.54 / $95,911.60 / $156,993.47
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$740.49 / $61,065.20 / $87,247.49
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68,022.77 / $94,756.59 / $111,362.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61,390.53 / $101,071.74 / $127,409.16