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Washington rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,837.00 / $38,019.50 / $66,952.30
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,762.20 / $32,535.28 / $47,614.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,041.16 / $29,562.17 / $49,523.55
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,115.84 / $24,762.20 / $30,705.62
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,307.19 / $28,519.14 / $44,647.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,560.21 / $31,600.88 / $42,963.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $23,813.97 / $65,067.48