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Massachusetts 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
$20,292.50 / $42,079.40 / $54,940.60
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,840.42 / $38,427.16 / $102,900.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,776.29 / $39,314.61 / $59,404.84
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55,830.79 / $55,830.79 / $55,830.79
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34,256.98 / $39,605.92 / $61,160.85
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,840.42 / $38,427.16 / $102,900.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,840.42 / $38,427.16 / $80,417.59