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New Hampshire rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,394.56 / $43,167.10 / $83,670.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,166.00 / $39,566.62 / $75,803.67
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36,543.42 / $53,102.01 / $79,129.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43,247.08 / $43,247.08 / $75,261.82