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Massachusetts 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
$89.79 / $89.79 / $89.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.66 / $110.14 / $894.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.33 / $4,208.41 / $4,208.41
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.98 / $313.77 / $4,977.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.70 / $630.72 / $630.72
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.27 / $808.87 / $951.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.62 / $1,761.79 / $2,453.80
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.33 / $4,208.41 / $4,208.41
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.94 / $300.12 / $4,977.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.28 / $350.17 / $2,102.32