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Oklahoma 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
$846.27 / $846.27 / $846.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.71 / $746.23 / $846.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,878.46 / $6,117.46 / $9,735.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.62 / $713.13 / $1,162.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.86 / $846.27 / $1,158.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.92 / $827.90 / $1,666.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.46 / $827.90 / $1,275.32