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Washington 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
$41,890.60 / $66,814.60 / $117,661.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,622.00 / $56,063.44 / $81,373.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,734.66 / $51,951.92 / $87,031.61
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,820.46 / $43,100.10 / $51,703.59
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,382.20 / $48,739.05 / $77,568.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,620.26 / $55,103.49 / $74,727.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,775.00 / $41,850.16 / $114,348.18