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Arkansas rates for HCPCS G0460

Autologous Platelet Rich Plasma Or Other Blood-Derived Product For Non-Diabetic Chronic Wounds/Ulcers Including As Applicable Phlebotomy Centrifugation Or Mixing And All Other Preparatory Procedures Administration And Dressings Per Treatment (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.22 / $77.22 / $77.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.22 / $89.79 / $846.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,638.24 / $1,638.24 / $1,965.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.01 / $189.72 / $274.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.31 / $630.72 / $630.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.22 / $184.37 / $417.34