go back

Kansas 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
$478.63 / $478.63 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $512.86 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $537.03 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $3,801.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $977.24 / $1,288.25