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Oregon 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
Facility
Modifier
Low / Median / High Price
$61.75 / $61.75 / $120.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.75 / $722.35 / $1,080.60
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
$360.35 / $445.53 / $1,952.37
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.91 / $1,080.60 / $1,701.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.28 / $80.28 / $80.28
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.58 / $124.47 / $1,536.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.91 / $1,080.60 / $2,323.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.87 / $444.74 / $2,250,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,573.85 / $6,178.58 / $7,048.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.94 / $1,619.11 / $2,092.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.51 / $360.60 / $1,980.86