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Minnesota 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
$537.03 / $537.03 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $549.54 / $933.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $4,570.88 / $13,182.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $398.11 / $2,691.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $3,548.13 / $8,511.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,047.13 / $1,348.96
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,388.44 / $6,606.93
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $1,047.13 / $1,122.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $912.01 / $1,949.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,348.96 / $3,981.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $5,370.32 / $7,244.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $1,380.38 / $2,951.21