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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)  (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$539.89 / $539.89 / $539.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.79 / $539.89 / $591.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$809.17 / $3,717.82 / $7,153.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.85 / $335.36 / $1,679.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,362.17 / $3,351.58 / $8,062.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.61 / $813.94 / $1,336.83
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,860.94 / $3,064.15 / $6,348.58
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.63 / $134.13 / $1,052.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.99 / $907.90 / $1,951.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.99 / $1,421.98 / $3,336.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.33 / $1,302.31 / $3,045.44