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Ohio rates for HCPCS Q4256

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

Facilitymedian $741 · 10th–90th $102$1,1480%20%10th90th$741Professionalmedian $741 · 10th–90th $141$1,0000%50%10th90th$741$2.0$10.0$50.0$200.0$1.0K

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
$741.31 / $741.31 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $812.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $794.33 / $1,380.38
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $741.31
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $181.97
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $741.31
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $117.49 / $912.01
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $158.49
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $1,995.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $933.25