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Arizona 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
Professional
Modifier
Low / Median / High Price
$74.06 / $701.43 / $747.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.29 / $152.74 / $241.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.00 / $450.59 / $807.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.48 / $492.22 / $1,107.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.26 / $825.84 / $1,772.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.14 / $786.51 / $1,078.18