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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $512.86 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $537.03 / $977.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,951.21 / $3,630.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $245.47 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $933.25 / $1,479.11
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
$109.65 / $112.20 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $5,011.87 / $7,244.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $954.99 / $1,584.89