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Louisiana 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
$16,993.59 / $23,448.50 / $39,244.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,272.00 / $25,796.72 / $39,963.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,392.84 / $26,380.57 / $44,240.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,062.00 / $26,901.17 / $47,342.07