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Montana 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
Professional
Modifier
Low / Median / High Price
$777.99 / $777.99 / $777.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$813.94 / $813.94 / $813.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.94 / $813.94 / $813.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.96 / $654.45 / $1,068.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.58 / $174.83 / $1,781.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.06 / $1,353.47 / $1,453.94