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South Dakota 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
$19,066.70 / $19,066.70 / $19,066.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,655.65 / $15,172.28 / $15,172.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,949.60 / $12,610.80 / $18,881.43
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,949.60 / $12,610.80 / $23,157.77