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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)  (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.51 / $937.70 / $985.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $1,552.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.61 / $1,168.33 / $1,379.60