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New Hampshire 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
$83.18 / $776.25 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $776.25 / $933.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $89.13 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $1,174.90 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $1,202.26 / $2,818.38
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $4,168.69