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Maryland 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
$467.74 / $707.95 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,258.93 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $870.96 / $1,621.81
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,318.26 / $1,819.70