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Indiana 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
$708.19 / $708.19 / $708.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.33 / $708.19 / $846.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.42 / $199.12 / $500.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,684.66 / $16,812.05 / $23,611.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.63 / $803.63 / $803.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.72 / $630.72 / $630.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.18 / $130.13 / $336.56