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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)  (Desc Rvsd 7/1/23)

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