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Utah rates for MS-DRG 138

Mouth procedures without CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,433.40 / $16,029.70 / $23,090.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,096.80 / $20,155.28 / $23,166.85
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,180.56 / $11,451.69 / $16,482.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $8,479.16