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North Carolina 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
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $741.31 / $933.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $954.99 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $776.25 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $776.25 / $1,479.11
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $7,762.47