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Alaska rates for HCPCS G0460

Autologous platelet rich plasma (PRP) or other blood-derived product for nondiabetic chronic wounds/ulcers (includes, as applicable: administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,218.00 / $1,218.00 / $1,218.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.71 / $793.87 / $1,162.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.72 / $630.72 / $630.72
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.65 / $1,162.95 / $1,663.02
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.36 / $174.80 / $286.89
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.68 / $664.40 / $3,096.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.65 / $1,162.95 / $1,628.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.00 / $630.72 / $2,271.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.52 / $534.82 / $1,970.98