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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)  (Desc Rvsd 7/1/23)

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
$506.16 / $736.71 / $736.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.37 / $868.97 / $1,874.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.16 / $521.75 / $884.05
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.16 / $477.16 / $477.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.61 / $769.94 / $1,411.27
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.09 / $455.09 / $455.09
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.22 / $4,977.89 / $7,755.23