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Alaska rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,538.90 / $96,687.00 / $196,442.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147,790.85 / $147,790.85 / $157,025.03
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,500.00 / $57,116.70 / $94,715.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,500.00 / $60,037.00 / $157,025.03