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Iowa rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,755.00 / $17,855.50 / $21,990.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,441.87 / $15,771.10 / $16,044.31
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,090.38 / $18,216.18 / $28,544.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,272.23 / $23,018.90 / $30,378.74