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Minnesota 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 / $812.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,445.44 / $1,479.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $125.89 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,884.03 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,047.13 / $1,202.26
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $3,019.95 / $3,715.35
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,023.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $977.24 / $1,862.09