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Missouri rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $16,595.87 / $21,379.62
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $7,762.47 / $7,762.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $17,378.01 / $28,840.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151,356.12 / $151,356.12 / $151,356.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,488.17 / $19,952.62 / $27,542.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $18,197.01 / $30,902.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,964.78 / $16,982.44 / $26,302.68