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California rates for MS-DRG 694

Urinary Stones Without Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,103.90 / $15,958.00 / $20,199.90
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,014.00 / $3,014.00 / $3,014.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,664.54 / $14,970.84 / $26,144.08
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $10,607.67 / $21,513.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,703.22 / $17,270.00 / $25,078.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,260.55 / $20,707.09 / $24,301.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,518.71 / $15,279.89 / $25,628.03
Sutter Health Plus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,869.00 / $10,869.00 / $10,869.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,017.00 / $13,510.12 / $27,422.82