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Indiana rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,238.20 / $28,595.20 / $38,372.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,584.70 / $23,905.03 / $38,248.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,154.85 / $23,023.50 / $52,802.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,762.91 / $22,679.68 / $32,128.53