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California 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
$8,802.00 / $46,373.70 / $69,703.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,736.02 / $40,249.61 / $91,977.82
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $36,181.25 / $72,900.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36,636.01 / $55,002.68 / $94,635.58
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48,537.00 / $69,337.25 / $81,373.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,569.27 / $45,842.31 / $88,434.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,693.00 / $41,769.24 / $85,512.97