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New Jersey rates for MS-DRG 694

Urinary Stones Without Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,412.80 / $17,597.59 / $22,818.60
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,334.12 / $17,334.12 / $17,334.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,083.93 / $17,504.00 / $23,708.96
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,817.00 / $4,817.00 / $4,817.00
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,547.00 / $12,837.00 / $19,084.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,908.00 / $15,355.00 / $21,358.00