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Texas rates for MS-DRG 574

Skin graft for skin ulcer or cellulitis with CC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,804.00 / $49,902.00 / $78,696.60
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49,280.06 / $49,280.06 / $49,280.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.00 / $2,914.00 / $49,754.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,506.90 / $48,360.07 / $91,506.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65,833.10 / $107,758.39 / $107,758.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,534.00 / $42,906.50 / $100,083.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,538.46 / $34,991.71 / $87,854.19