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Pennsylvania rates for MS-DRG 117

Intraocular procedures w/o CC/MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,237.10 / $17,737.00 / $24,221.50
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $16,625.00 / $26,570.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,934.15 / $16,631.52 / $24,404.83
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,876.98 / $17,876.98 / $21,707.76
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,885.51 / $9,885.51 / $18,965.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,783.62 / $17,061.00 / $23,969.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,286.73 / $14,667.85 / $22,869.69
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $8,654.98 / $11,988.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,130.00 / $13,675.16 / $24,805.15