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Wisconsin rates for MS-DRG 176

Complicated Peptic Ulcer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,105.60 / $12,105.60 / $14,347.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,875.60 / $14,441.08 / $21,602.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,900.87 / $12,254.43 / $20,849.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,858.15 / $14,212.92 / $23,264.50
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.56 / $8,240.29 / $11,871.34
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,080.14 / $14,041.76 / $16,502.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,097.32 / $14,977.59 / $18,880.47