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Pennsylvania rates for MS-DRG 694

Urinary Stones Without Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,049.37 / $12,780.00 / $17,452.20
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,267.54 / $8,267.54 / $8,267.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,459.92 / $12,843.00 / $19,801.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,770.30 / $12,194.52 / $17,584.34
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,880.85 / $12,880.85 / $15,641.04
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,039.07 / $12,465.57 / $17,547.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,036.86 / $12,507.20 / $17,452.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,437.30 / $11,436.27 / $16,478.24
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $6,338.93 / $8,684.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,635.69 / $9,987.00 / $16,400.07