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Pennsylvania rates for MS-DRG 137

Mouth procedures with CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,089.80 / $24,412.30 / $33,337.19
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,593.00 / $24,125.58 / $36,718.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,571.00 / $22,890.76 / $33,220.71
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,604.95 / $24,604.95 / $29,877.44
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,620.63 / $27,385.71 / $34,985.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,465.70 / $23,891.20 / $32,990.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,165.98 / $20,188.06 / $31,131.73
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $11,095.86 / $15,543.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,944.87 / $18,821.79 / $34,140.51