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South Carolina rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,078.00 / $26,753.30 / $26,753.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,617.87 / $20,118.65 / $32,788.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,696.64 / $30,202.23 / $46,292.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,563.03 / $39,968.80 / $51,606.41