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Pennsylvania rates for MS-DRG 187

Dental Extractions & Restorations

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,053.23 / $16,306.30 / $22,826.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,871.00 / $19,767.50 / $28,025.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,656.60 / $15,162.90 / $22,005.50
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,298.39 / $16,298.39 / $19,790.90
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,879.40 / $19,331.97 / $23,452.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,919.70 / $16,170.80 / $22,725.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,145.24 / $13,857.00 / $21,164.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $8,057.12 / $11,157.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,404.00 / $12,467.61 / $22,614.78