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Georgia 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
$697.21 / $697.21 / $697.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.38 / $678.35 / $937.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.34 / $775.82 / $950.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.80 / $98.34 / $888.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.14 / $998.46 / $1,766.96