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California rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,501.70 / $29,247.50 / $47,426.50
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,042.00 / $9,042.00 / $9,042.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,984.65 / $23,551.37 / $53,819.24
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $20,166.71 / $44,708.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,480.05 / $31,927.45 / $56,542.65
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,940.75 / $40,571.50 / $47,614.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,261.02 / $25,781.72 / $56,542.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,693.00 / $23,767.93 / $48,659.40