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South Dakota rates for MS-DRG 175

Pulmonary embolism w MCC or acute cor pulmonale

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,314.20 / $19,314.20 / $19,314.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,845.87 / $15,369.21 / $15,369.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,065.76 / $12,774.48 / $24,064.61
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.00 / $950.00 / $950.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,065.76 / $12,774.48 / $23,458.34