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Wisconsin 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
$40,738.03 / $47,863.01 / $50,118.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,512.09 / $51,286.14 / $74,131.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,902.95 / $42,657.95 / $75,857.76
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35,481.34 / $40,738.03 / $51,286.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,512.09 / $47,863.01 / $77,624.71
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $30,902.95 / $39,810.72
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,668.36 / $54,954.09 / $57,543.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,199.52 / $51,286.14 / $69,183.10