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South Carolina 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
$117.49 / $630.96 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $676.08 / $891.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $74.13 / $83.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,089.30 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $123.03 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $741.31 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $10,000.00 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $741.31 / $1,122.02