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Hawaii 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
Professional
Modifier
Low / Median / High Price
$478.63 / $707.95 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,258.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $1,202.26 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,122.02 / $1,412.54