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Michigan rates for HCPCS Q4256

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

Facilitymedian $759 · 10th–90th $102–$2,5120%50%10th90th$759Professionalmedian $741 · 10th–90th $741–$9120%50%90th$741$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $758.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,047.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,511.89 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $758.58 / $2,951.21
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $933.25