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Idaho rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,507.10 / $13,507.10 / $13,507.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,651.83 / $53,744.52 / $56,146.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,747.40 / $30,188.03 / $31,515.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,764.00 / $19,745.86 / $32,705.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,686.68 / $19,953.70 / $28,882.21