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West Virginia 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
Facility
Modifier
Low / Median / High Price
$59.80 / $544.24 / $653.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.89 / $678.35 / $896.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $121.00 / $121.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.98 / $818.96 / $4,290.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.61 / $930.89 / $1,456.70