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Pennsylvania rates for MS-DRG 158

Dental and oral diseases with CC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,584.87 / $14,874.30 / $20,312.20
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $15,953.00 / $23,802.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,962.57 / $14,192.88 / $20,241.23
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,991.68 / $14,991.68 / $18,204.18
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,271.65 / $15,859.62 / $20,483.18
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,204.58 / $14,874.30 / $20,101.09
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,492.20 / $13,310.37 / $19,827.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $7,569.47 / $10,453.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,130.00 / $11,468.03 / $20,801.66