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Hawaii rates for MS-DRG 122

Acute Major Eye Infections Without Cc/Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,594.00 / $3,594.00 / $3,594.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,716.05 / $20,716.05 / $20,716.05
HMSA
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,582.00 / $8,860.00 / $10,317.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $3,775.00