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Nebraska 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
$709.74 / $709.74 / $709.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.79 / $709.74 / $877.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,281.85 / $5,631.80 / $10,893.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.51 / $118.55 / $196.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.44 / $320.87 / $1,304.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.19 / $1,100.09 / $1,695.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.00 / $353.00 / $4,977.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.38 / $929.89 / $1,408.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $330.48 / $1,304.86
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.70 / $1,076.70 / $1,076.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.08 / $353.00 / $1,692.73