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Texas rates for MS-DRG 158

Dental & Oral Diseases w CC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,804.00 / $13,546.00 / $20,625.20
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,665.89 / $21,665.89 / $21,665.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.00 / $2,914.00 / $13,561.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,569.54 / $12,282.30 / $21,997.14
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,871.40 / $29,252.66 / $29,252.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,792.70 / $19,792.70 / $54,782.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,003.00 / $11,245.13 / $21,997.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,800.00 / $10,189.76 / $23,296.34