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Texas rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,804.00 / $55,147.90 / $83,269.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.00 / $2,914.00 / $53,299.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31,221.35 / $51,169.96 / $96,822.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73,360.89 / $120,080.21 / $120,080.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,309.00 / $45,399.52 / $105,899.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,257.00 / $41,138.72 / $93,671.40