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Idaho rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,323.30 / $32,323.30 / $32,323.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97,282.05 / $128,613.60 / $134,362.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60,215.83 / $70,124.69 / $77,242.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,764.00 / $41,723.76 / $68,074.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,539.08 / $47,750.30 / $69,116.72