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Iowa 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
$25,930.10 / $31,378.90 / $38,645.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,379.84 / $27,715.79 / $28,195.92
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,762.13 / $32,012.74 / $50,163.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,353.84 / $40,452.91 / $53,386.94