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Illinois 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
$134.59 / $514.79 / $819.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.75 / $514.79 / $819.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,192.85 / $2,616.16 / $3,375.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.83 / $200.58 / $913.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.54 / $979.58 / $1,560.23
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.54 / $112.88 / $1,188.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.02 / $1,343.42 / $1,370.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.60 / $989.68 / $1,688.59