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New Hampshire rates for MS-DRG 255

Upper limb and toe amputation for circulatory system disorders with MCC

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,506.28 / $29,278.63 / $56,699.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,166.00 / $35,668.00 / $55,667.65
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,763.28 / $38,996.31 / $57,290.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31,759.19 / $31,759.19 / $55,269.73