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Pennsylvania rates for MS-DRG 122

Acute Major Eye Infections Without Cc/Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,414.81 / $12,847.00 / $17,543.80
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,965.00 / $11,912.50 / $18,167.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,471.06 / $12,046.31 / $17,482.48
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,948.41 / $12,948.41 / $15,723.07
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,246.79 / $6,246.79 / $17,186.49
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,086.34 / $12,572.80 / $17,361.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,124.00 / $10,624.02 / $16,383.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $5,583.21 / $7,538.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,420.75 / $9,905.01 / $17,966.53