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Virginia 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
$30,189.30 / $46,754.00 / $54,679.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,163.50 / $44,148.20 / $62,270.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,877.63 / $38,400.19 / $60,181.69
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,832.00 / $37,227.00 / $56,009.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,958.00 / $43,603.47 / $71,883.00