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North Dakota 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
$793.87 / $793.87 / $793.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.45 / $539.89 / $793.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.71 / $229.76 / $2,128.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.63 / $123.28 / $1,315.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.18 / $793.87 / $1,349.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.18 / $1,399.59 / $1,988.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.95 / $987.95 / $1,988.92