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Wyoming 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
$83.18 / $83.18 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $537.03 / $1,071.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $933.25 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,288.25 / $2,511.89