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South Dakota rates for MS-DRG 694

Urinary Stones Without Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,991.50 / $10,991.50 / $10,991.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,448.61 / $8,746.44 / $8,746.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,159.22 / $7,269.81 / $13,344.75
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.00 / $950.00 / $950.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,716.57 / $8,172.67 / $13,376.45