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Connecticut 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)  (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$989.08 / $989.08 / $989.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.16 / $821.32 / $989.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.69 / $261.97 / $874.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.31 / $1,042.15 / $1,683.39