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Massachusetts rates for MS-DRG 694

Urinary Stones Without Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,880.73 / $12,194.50 / $15,921.70
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,840.42 / $10,992.27 / $29,820.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,890.31 / $11,393.28 / $17,215.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,179.63 / $16,179.63 / $16,179.63
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,927.59 / $11,477.70 / $17,724.27
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,840.42 / $10,992.27 / $29,820.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $10,992.27 / $25,954.00