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Vermont 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
$87.92 / $106.07 / $792.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.97 / $630.72 / $630.72
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.97 / $290.36 / $630.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.80 / $297.22 / $1,790.65