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Wisconsin 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
$701.58 / $701.58 / $701.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.33 / $701.58 / $815.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.57 / $1,092.99 / $2,657.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$523.54 / $611.80 / $938.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.44 / $272.33 / $630.72
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.58 / $609.71 / $877.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.58 / $423.42 / $890.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.26 / $274.48 / $4,977.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.40 / $70.00 / $291.67
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.99 / $609.71 / $877.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$985.96 / $1,804.92 / $2,523.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.63 / $4,060.36 / $4,060.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.72 / $3,288.51 / $4,977.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.48 / $310.48 / $779.90