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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)  (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.32 / $821.32 / $821.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.08 / $821.32 / $989.08
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.09 / $455.09 / $455.09
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.31 / $1,155.39 / $4,977.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.29 / $3,084.67 / $4,017.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.94 / $141.13 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.54 / $1,317.06 / $1,856.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.59 / $958.14 / $2,457.34
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.09 / $455.09 / $455.09
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.31 / $1,155.39 / $4,977.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.31 / $1,127.22 / $1,749.58