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Texas rates for MS-DRG 694

Urinary Stones Without Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,804.00 / $11,254.00 / $17,721.09
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,609.72 / $11,953.96 / $14,750.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.00 / $2,753.00 / $11,266.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,486.00 / $10,431.00 / $18,576.32
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,846.60 / $24,301.54 / $24,301.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,453.41 / $3,994.85 / $8,191.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,644.45 / $9,661.81 / $18,899.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,375.00 / $10,580.00 / $20,415.66