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Arizona 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
$29,927.70 / $43,703.30 / $57,441.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,665.29 / $34,492.35 / $58,339.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,402.40 / $43,897.49 / $73,474.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,644.91 / $48,990.18 / $71,529.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,644.91 / $45,542.90 / $71,529.64