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Pennsylvania rates for MS-DRG 138

Mouth Procedures Without Cc/Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,111.39 / $14,488.50 / $19,785.30
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,534.00 / $14,607.22 / $22,036.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,675.38 / $13,585.45 / $21,450.47
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,602.80 / $14,602.80 / $17,731.98
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,743.89 / $15,806.17 / $19,561.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,991.75 / $14,179.20 / $19,785.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,297.86 / $11,981.42 / $18,681.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $6,593.72 / $9,041.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,130.00 / $11,170.55 / $20,262.08