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Virginia 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
$868.89 / $868.89 / $896.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.58 / $868.89 / $896.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.34 / $261.97 / $890.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $121.00 / $121.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.64 / $1,105.65 / $1,296.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.79 / $868.89 / $1,263.59
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.52 / $1,216.92 / $1,354.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.95 / $789.90 / $1,105.85
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.92 / $789.90 / $1,105.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.35 / $923.70 / $1,456.70