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South Dakota 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
$76,383.60 / $76,383.60 / $76,383.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58,712.30 / $60,782.00 / $60,782.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35,853.18 / $50,520.39 / $98,547.35
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35,853.18 / $50,520.39 / $92,772.82