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New York rates for MS-DRG 804

Other O.R. proc of the blood & blood forming organs w/o CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,789.70 / $23,625.60 / $39,889.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,429.84 / $31,752.83 / $41,428.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $3,500.00 / $3,500.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,552.16 / $33,678.67 / $49,438.40
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,331.04 / $33,302.00 / $69,835.36
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,552.16 / $36,668.00 / $49,710.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,823.39 / $31,011.72 / $46,620.64