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New Hampshire rates for MS-DRG 257

Upper limb & toe amputation for circ system disorders w/o CC/MCC

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,597.00 / $12,726.76 / $19,327.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,774.83 / $22,897.43 / $35,672.00
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,441.83 / $14,740.43 / $22,027.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,859.56 / $12,859.56 / $22,379.18