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South Dakota rates for MS-DRG 138

Mouth Procedures Without Cc/Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,460.90 / $12,460.90 / $12,460.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,578.04 / $9,915.69 / $9,915.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,848.92 / $8,241.66 / $13,892.95
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,848.92 / $8,241.66 / $15,134.52