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New Hampshire rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,144.62 / $17,131.89 / $33,176.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,358.16 / $31,017.00 / $35,672.00
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,489.97 / $22,190.05 / $32,599.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,071.91 / $18,071.91 / $31,450.10