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Michigan 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
$487.44 / $487.44 / $492.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.89 / $492.22 / $654.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.44 / $134.44 / $134.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.73 / $139.83 / $181.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.25 / $818.96 / $1,115.78
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.44 / $846.53 / $846.53
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.44 / $846.53 / $1,058.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.72 / $869.30 / $1,130.26