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New Hampshire rates for MS-DRG 158

Dental and oral diseases with CC

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,786.75 / $11,031.97 / $20,382.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,474.40 / $19,073.50 / $28,883.00
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,901.83 / $13,152.98 / $19,323.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,711.99 / $10,711.99 / $18,641.80