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Hawaii rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,606.00 / $4,606.00 / $4,606.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,464.57 / $40,464.57 / $40,464.57
HMSA
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,793.00 / $17,285.00 / $20,128.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $3,775.00