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Hawaii rates for MS-DRG 138

Mouth Procedures Without Cc/Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,606.00 / $4,606.00 / $4,606.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,362.89 / $23,362.89 / $23,362.89
HMSA
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,381.00 / $30,826.00 / $35,896.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $3,775.00