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New Mexico 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
$588.84 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $630.96 / $1,071.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,234.13 / $69,183.10 / $81,283.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $218.78 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $85.11 / $1,174.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $645.65 / $1,905.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $8,912.51 / $8,912.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,202.26 / $1,479.11