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Utah rates for MS-DRG 187

Dental Extractions & Restorations

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,877.10 / $17,891.00 / $25,812.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,617.52 / $24,183.59 / $28,591.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,096.21 / $13,570.06 / $20,342.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $9,463.70