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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)  (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.79 / $821.32 / $998.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,125.75 / $3,950.70 / $5,385.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.38 / $126.89 / $923.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.92 / $941.27 / $1,409.86