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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
$14,454.40 / $14,454.40 / $19,054.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,791.08 / $15,488.17 / $15,488.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $12,589.25 / $19,054.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $14,125.38 / $22,908.68