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Washington rates for MS-DRG 137

Mouth procedures with CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,189.40 / $36,986.60 / $65,133.40
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,325.54 / $30,552.93 / $43,496.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,442.35 / $28,759.03 / $48,178.10
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,621.82 / $24,755.22 / $28,805.98
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,851.31 / $26,079.23 / $41,821.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,699.28 / $29,747.92 / $40,784.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $23,167.00 / $63,299.73