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Alaska rates for MS-DRG 255

Upper limb and toe amputation for circulatory system disorders with MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,114.10 / $71,003.70 / $144,260.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108,532.59 / $108,532.59 / $115,313.85
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,500.00 / $41,944.57 / $64,183.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,500.00 / $40,683.47 / $115,313.85