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New Jersey 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
$37,763.60 / $60,489.20 / $78,739.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34,796.46 / $60,400.00 / $81,812.14
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,817.00 / $4,817.00 / $4,817.00
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,140.00 / $44,377.00 / $68,382.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,098.00 / $19,347.00 / $74,612.78