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Utah rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,534.60 / $27,763.50 / $33,705.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,683.69 / $37,528.46 / $43,599.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,395.74 / $20,693.00 / $31,019.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $14,685.92