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Massachusetts 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
$812.83 / $812.83 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $741.31 / $1,071.52
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $1,148.15 / $5,011.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,090.30 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $138.04 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,513.56 / $2,137.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $1,096.48 / $2,691.53
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $1,174.90 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $4,466.84 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $1,096.48 / $2,454.71