go back

Pennsylvania rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,619.90 / $60,051.50 / $82,005.60
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,946.00 / $55,457.72 / $83,874.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,056.02 / $50,688.78 / $81,391.99
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60,525.34 / $60,525.34 / $73,495.06
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65,722.23 / $78,899.75 / $533,271.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,124.00 / $57,678.70 / $81,153.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,056.02 / $49,171.79 / $77,828.19
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $29,532.68 / $42,911.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,889.57 / $46,299.43 / $83,981.76