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New Hampshire 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
$87.92 / $87.92 / $105.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.38 / $89.79 / $722.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $500.00 / $500.00
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 / $1,336.39 / $2,621.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.66 / $389.64 / $1,576.47