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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
$81.28 / $501.19 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $630.96 / $1,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $125.89 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,318.26
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $144.54 / $346.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,513.56 / $2,454.71
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $812.83 / $977.24
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,288.25 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $4,677.35 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $870.96 / $1,698.24
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $97.72 / $97.72
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $741.31 / $851.14