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Utah rates for MS-DRG 694

Urinary Stones Without Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $13,803.84 / $15,488.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,481.54 / $16,982.44 / $22,387.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $12,589.25 / $16,218.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $12,302.69 / $12,882.50