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Maryland 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
Professional
Modifier
Low / Median / High Price
$71.66 / $606.51 / $896.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,369.00 / $1,369.00 / $1,369.00
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.45 / $247.35 / $366.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.42 / $201.29 / $748.86