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Washington rates for MS-DRG 575

Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,907.40 / $44,511.70 / $78,385.10
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,864.44 / $42,431.87 / $62,097.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,804.92 / $34,610.22 / $57,980.21
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,960.65 / $29,974.40 / $38,790.40
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,375.04 / $37,192.80 / $58,392.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,505.37 / $41,329.19 / $56,189.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,887.16 / $16,606.08 / $40,286.94