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South Dakota rates for MS-DRG 176

Complicated Peptic Ulcer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,319.10 / $11,319.10 / $11,319.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,700.44 / $9,007.15 / $9,007.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,313.00 / $7,486.50 / $13,910.03
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
$5,313.00 / $7,486.50 / $13,747.79