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Rhode Island 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
$512.86 / $588.84 / $1,000.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,981.07 / $5,623.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $89.13 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,000.00 / $1,621.81