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Pennsylvania rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,483.30 / $25,094.10 / $34,268.19
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,467.00 / $23,930.00 / $35,703.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,639.90 / $23,530.02 / $34,148.46
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,292.08 / $25,292.08 / $30,711.81
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,510.00 / $31,796.96 / $50,622.70
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,841.70 / $24,558.40 / $33,912.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,723.93 / $20,751.84 / $32,273.48
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $12,037.66 / $17,015.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,138.82 / $19,347.41 / $35,093.94