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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
$40,563.50 / $40,563.50 / $48,075.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,512.00 / $46,390.54 / $69,397.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,175.94 / $41,062.25 / $69,862.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,681.95 / $47,624.75 / $77,954.86
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.42 / $26,471.13 / $39,778.56
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33,776.60 / $47,051.23 / $55,297.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,483.37 / $50,187.02 / $63,264.82