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Rhode Island 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
$83.39 / $110.14 / $748.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,521.69 / $3,542.30 / $4,142.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $208.77 / $350.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.70 / $630.72 / $630.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.06 / $235.95 / $1,156.50