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Pennsylvania rates for MS-DRG 576

Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,247.70 / $80,129.70 / $109,424.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,946.00 / $77,327.62 / $122,039.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36,636.47 / $67,636.56 / $109,041.90
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80,761.97 / $80,761.97 / $98,068.11
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,199.00 / $78,419.20 / $108,287.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36,636.47 / $65,612.36 / $108,753.06
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $41,111.71 / $59,961.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,398.48 / $61,779.63 / $112,061.04