go back

New York 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
$84.99 / $678.35 / $846.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.16 / $606.51 / $896.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $131.32 / $325.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $121.00 / $121.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.80 / $196.83 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.83 / $1,275.84 / $2,626.13
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.85 / $804.54 / $977.89
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $555.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.52 / $818.96 / $1,594.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.32 / $910.69 / $1,947.43
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.13 / $98.13 / $98.13
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.13 / $801.80 / $913.48