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New Hampshire rates for MS-DRG 117

Intraocular procedures w/o CC/MCC

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,440.46 / $12,648.78 / $23,373.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,682.76 / $22,744.39 / $35,672.00
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,208.95 / $15,684.40 / $23,042.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,773.61 / $12,773.61 / $22,229.60