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Louisiana rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,140.50 / $31,930.30 / $53,439.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,272.00 / $35,733.54 / $58,631.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,684.15 / $35,922.92 / $60,242.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,062.00 / $36,631.83 / $64,466.58