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South Dakota rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51,647.50 / $51,647.50 / $51,647.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,698.86 / $41,098.32 / $41,098.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,242.46 / $34,159.83 / $65,939.87
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,242.46 / $34,159.83 / $62,729.20