go back

South Dakota rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,582.20 / $21,582.20 / $21,582.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,589.20 / $17,174.00 / $17,174.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,130.34 / $14,274.57 / $26,146.42
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,130.34 / $14,274.57 / $26,213.02