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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
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.75 / $1,264.40 / $1,264.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.09 / $1,011.52 / $1,264.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.64 / $1,264.40 / $1,851.18