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Washington rates for MS-DRG 138

Mouth Procedures Without Cc/Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,762.70 / $21,951.20 / $38,656.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,502.31 / $17,411.34 / $25,299.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,725.83 / $17,068.21 / $28,593.24
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,915.02 / $14,398.95 / $17,787.43
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,409.00 / $15,154.69 / $24,118.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,484.26 / $17,257.08 / $23,464.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $13,749.39 / $37,567.79