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Washington rates for MS-DRG 694

Urinary Stones Without Mcc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,139.80 / $19,362.70 / $34,097.80
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,746.00 / $16,419.48 / $23,869.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,225.21 / $15,055.54 / $25,221.55
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,329.56 / $13,110.40 / $16,737.12
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,409.00 / $14,556.70 / $22,338.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,287.32 / $15,810.54 / $21,495.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,425.57 / $17,084.84 / $23,958.32