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Idaho 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
$79.43 / $79.43 / $977.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $707.95 / $1,071.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $4,073.80 / $6,025.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $102.33 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $660.69 / $741.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $741.31 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,570.88 / $6,025.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $851.14 / $1,445.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $977.24 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,023.29 / $1,380.38