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Wisconsin rates for MS-DRG 904

Skin grafts for injuries w CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55,236.10 / $55,236.10 / $65,465.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42,074.40 / $68,457.30 / $102,407.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45,176.30 / $55,915.23 / $95,133.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,418.46 / $64,851.52 / $106,152.59
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.92 / $39,062.75 / $55,811.27
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45,994.23 / $64,070.54 / $75,298.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41,509.78 / $68,340.60 / $86,148.89