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North Carolina rates for HCPCS G0460

Autologous platelet rich plasma (PRP) or other blood-derived product for nondiabetic chronic wounds/ulcers (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
$736.71 / $736.71 / $736.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.39 / $696.93 / $800.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.89 / $375.23 / $755.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.63 / $803.63 / $803.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.95 / $630.72 / $630.72
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.26 / $225.60 / $884.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.86 / $526.87 / $1,059.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.86 / $146.06 / $495.59
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.33 / $1,236.92 / $4,208.41
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,977.89 / $4,977.89 / $4,977.89