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New Hampshire rates for MS-DRG 114

Orbital procedures w/o CC/MCC

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,466.25 / $15,790.83 / $25,616.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,064.04 / $28,364.97 / $35,672.00
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,188.58 / $19,536.57 / $27,287.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,930.22 / $15,930.22 / $27,722.97