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Hawaii rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,606.00 / $4,606.00 / $4,606.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96,833.94 / $96,833.94 / $96,833.94
HMSA
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54,060.00 / $63,168.00 / $73,558.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $3,775.00