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Maine 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
$100.00 / $741.31 / $1,071.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $138.04 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $1,071.52 / $2,041.74
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $741.31 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $1,071.52 / $1,621.81