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Wisconsin rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,668.36 / $52,480.75 / $54,954.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34,673.69 / $46,773.51 / $83,176.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,904.51 / $44,668.36 / $56,234.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,113.11 / $52,480.75 / $85,113.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $33,884.42 / $44,668.36
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48,977.88 / $61,659.50 / $63,095.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,884.42 / $56,234.13 / $75,857.76