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South Dakota rates for MS-DRG 114

Orbital procedures w/o CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,024.50 / $19,024.50 / $19,024.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,623.22 / $15,138.72 / $15,138.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,929.79 / $12,582.90 / $20,187.90
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,929.79 / $12,582.90 / $23,106.53