go back

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
$851.14 / $851.14 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $741.31 / $933.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $5,754.40 / $9,332.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $151.36 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $851.14 / $1,202.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $831.76 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $3,235.94 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $794.33 / $1,122.02