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Washington rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48,977.88 / $74,131.02 / $123,026.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,651.58 / $61,659.50 / $97,723.72
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,738.03 / $52,480.75 / $53,703.18
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,668.36 / $66,069.34 / $95,499.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,908.68 / $66,069.34 / $93,325.43