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New Hampshire rates for MS-DRG 575

Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,276.29 / $20,869.68 / $43,268.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,663.76 / $31,098.00 / $37,085.62
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,469.62 / $25,979.23 / $40,918.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,157.88 / $21,157.88 / $36,820.53