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Arkansas rates for HCPCS G0465

Autologous platelet rich plasma (PRP) or other blood-derived product for diabetic chronic wounds/ulcers, using an FDA-cleared device for this indication, (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
$672.40 / $672.40 / $672.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.61 / $672.40 / $746.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.32 / $827.90 / $1,175.29