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Utah rates for MS-DRG 158

Dental and oral diseases with CC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,764.50 / $16,456.59 / $19,657.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,445.58 / $22,244.70 / $26,786.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,458.67 / $12,713.15 / $19,057.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $8,704.96