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South Dakota 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
$37,928.10 / $37,928.10 / $37,928.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,153.50 / $30,181.21 / $30,181.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,802.84 / $25,085.82 / $44,684.59
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,802.84 / $25,085.82 / $46,066.20