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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
$86.68 / $88.35 / $933.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.72 / $793.87 / $1,064.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.00 / $928.00 / $928.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.49 / $1,330.53 / $2,523.39