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Montana 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
$71.66 / $210.02 / $777.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,206.19 / $1,206.19 / $1,206.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.22 / $630.72 / $1,206.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.99 / $728.28 / $1,206.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.91 / $630.72 / $1,800,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.67 / $330.55 / $433.80