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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
$583.77 / $583.77 / $583.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.77 / $853.56 / $853.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.43 / $212.97 / $1,275.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $85.00 / $1,175.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.54 / $651.61 / $1,797.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.90 / $818.96 / $1,813.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.69 / $1,238.77 / $1,582.87