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Utah rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51,533.60 / $66,439.70 / $79,180.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54,283.31 / $89,807.66 / $109,956.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,827.22 / $52,186.63 / $78,229.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $35,144.22