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Illinois 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
$24,748.60 / $33,623.10 / $51,624.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,808.39 / $29,850.39 / $44,716.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,589.99 / $29,806.27 / $53,948.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.84 / $307.69 / $503.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,780.28 / $32,910.98 / $54,163.79