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Pennsylvania 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
$678.35 / $894.15 / $894.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.35 / $811.33 / $905.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.73 / $1,395.94 / $1,439.59
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,279.61 / $2,279.61 / $2,392.21
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$894.15 / $894.15 / $894.15
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.79 / $793.87 / $937.59
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $121.00 / $121.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.38 / $853.31 / $1,531.59