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Massachusetts rates for HCPCS Q4256

MLG-Complete, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $912.01
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $467.74 / $4,265.80
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,949.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $234.42 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $199.53 / $295.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $467.74 / $4,265.80
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,995.26 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $741.31 / $1,862.09