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Utah rates for MS-DRG 804

Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,024.70 / $24,527.60 / $30,907.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,039.80 / $27,392.35 / $33,154.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,117.91 / $16,340.31 / $22,400.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $12,974.21