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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
$46,223.50 / $73,725.39 / $129,831.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,600.00 / $62,437.88 / $90,971.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42,741.10 / $57,325.46 / $96,033.55
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,331.50 / $43,665.00 / $54,314.22
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,481.28 / $57,962.08 / $88,350.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $46,178.85 / $126,175.55