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Iowa 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
$74.13 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $588.84 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $1,047.13 / $1,318.26
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $776.25 / $1,380.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,348.96 / $4,897.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $1,122.02 / $2,344.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $954.99 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $5,128.61 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,174.90 / $2,041.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $213.80 / $2,137.96