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Vermont 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
$602.56 / $812.83 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,548.82 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,174.90 / $1,659.59