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Washington rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57,043.20 / $90,982.70 / $160,221.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,828.39 / $73,355.67 / $107,597.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52,745.72 / $70,743.91 / $118,512.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,240.32 / $59,074.51 / $68,198.61
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,489.64 / $66,117.14 / $96,227.22
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,957.66 / $70,405.56 / $96,119.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $56,988.15 / $155,710.06