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Wisconsin rates for MS-DRG 115

Extraocular Procedures Except Orbit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,081.80 / $23,081.80 / $27,356.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,683.30 / $27,144.63 / $40,606.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,878.09 / $23,365.63 / $39,753.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,889.90 / $27,099.89 / $44,358.61
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.42 / $15,489.13 / $22,635.17
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,219.88 / $26,773.54 / $31,465.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,345.93 / $28,557.89 / $35,999.54