go back

Utah 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
$37,844.50 / $48,791.10 / $55,620.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,863.82 / $64,826.40 / $74,512.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,311.52 / $35,364.61 / $53,012.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $3,775.00 / $25,808.72