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Michigan rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $20,417.38 / $26,915.35
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,892.96 / $20,892.96 / $20,892.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $18,620.87 / $23,442.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,988.33 / $23,988.33 / $23,988.33
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $19,498.45 / $25,703.96
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,988.33 / $23,988.33 / $23,988.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $17,782.79 / $27,542.29