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Texas 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)  (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.29 / $553.44 / $651.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.40 / $559.29 / $825.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.74 / $85.74 / $85.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,679.29 / $2,571.41 / $5,387.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.49 / $112.49 / $132.34
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.77 / $1,823.04 / $1,823.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.09 / $455.09 / $455.09
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.64 / $4,977.89 / $7,755.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.02 / $651.61 / $1,160.93
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.18 / $174.68 / $1,602.32
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.96 / $198.16 / $2,522.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.02 / $651.61 / $1,160.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.05 / $827.90 / $1,213.47
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.74 / $844.43 / $1,182.20