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Pennsylvania 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
$12,411.50 / $22,169.20 / $30,274.10
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,360.00 / $20,670.49 / $30,735.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,166.66 / $20,787.48 / $30,168.29
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,344.17 / $22,344.17 / $27,132.20
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,490.82 / $27,489.97 / $35,464.81
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,228.40 / $21,696.00 / $30,274.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,485.00 / $18,333.12 / $28,271.24
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $8,857.58 / $12,287.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,306.76 / $17,092.38 / $31,003.58