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Wisconsin rates for HCPCS Q4256

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

Facilitymedian $933 · 10th–90th $741$2,6920%20%10th90th$933Professionalmedian $741 · 10th–90th $182$2,1380%50%10th90th$741$5.0$20.0$100.0$500.0$2.0K$10.0K

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 / $812.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $2,290.87 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $1,995.26 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $954.99 / $1,202.26
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $758.58 / $1,659.59
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,071.52
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $831.76 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $2,238.72
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,698.24 / $1,698.24
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,023.29 / $1,659.59
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $275.42 / $549.54
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $1,905.46 / $4,265.80
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $831.76 / $4,265.80
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,230.27
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $933.25 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $933.25