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South Dakota rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31,622.78 / $31,622.78 / $41,686.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,359.37 / $33,884.42 / $33,884.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,498.45 / $27,542.29 / $52,480.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,877.62 / $30,902.95 / $51,286.14