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Texas rates for MS-DRG 138

Mouth procedures without CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,804.00 / $11,717.00 / $20,090.20
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,797.22 / $23,797.22 / $23,797.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.00 / $2,910.00 / $12,437.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,608.91 / $12,495.00 / $23,360.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,456.50 / $25,299.85 / $25,299.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,165.74 / $23,165.74 / $89,961.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,795.00 / $11,077.50 / $25,550.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,795.59 / $9,925.44 / $22,692.04