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Texas rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,804.00 / $22,049.00 / $34,796.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.00 / $3,030.00 / $22,073.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,178.65 / $21,382.69 / $40,459.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,089.00 / $47,614.10 / $47,614.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,501.00 / $19,186.25 / $44,252.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,257.00 / $17,190.88 / $39,302.65