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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)  (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.08 / $736.08 / $736.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.62 / $137.16 / $520.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.29 / $338.66 / $1,909.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.08 / $736.08 / $736.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.77 / $1,086.67 / $1,319.50