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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
$100.00 / $707.95 / $1,071.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $74.13 / $83.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $120.23 / $177.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $331.13 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $457.09 / $1,096.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $831.76 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $794.33 / $1,071.52