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Virginia rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,982.44 / $26,302.68 / $30,902.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,054.61 / $28,840.32 / $39,810.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,218.10 / $25,703.96 / $34,673.69
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,982.44 / $25,118.86 / $31,622.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $27,542.29 / $41,686.94