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
$423.45 / $423.45 / $423.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.45 / $514.38 / $574.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.09 / $514.38 / $1,073.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.72 / $1,012.99 / $4,977.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$791.65 / $992.44 / $1,287.63