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New Hampshire rates for MS-DRG 138

Mouth Procedures Without Cc/Mcc

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,557.68 / $10,389.75 / $17,628.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,176.75 / $18,578.74 / $35,672.00
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,699.78 / $12,811.79 / $18,460.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,434.12 / $10,434.12 / $18,158.24