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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
$467.74 / $467.74 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $512.86 / $933.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $83.18 / $954.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $691.83 / $870.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $1,023.29 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $537.03 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $912.01 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $6,456.54 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $831.76 / $1,288.25