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Missouri 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
$470.29 / $470.29 / $574.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.29 / $514.38 / $672.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.47 / $696.14 / $895.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.94 / $818.96 / $818.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.75 / $540.10 / $1,336.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.64 / $869.30 / $4,977.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.33 / $852.74 / $1,441.72