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Maine 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
Professional
Modifier
Low / Median / High Price
$111.58 / $197.73 / $800.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.00 / $500.00 / $500.00
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$849.47 / $1,094.05 / $2,052.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.58 / $197.73 / $748.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.16 / $238.98 / $1,471.34