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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $537.03 / $851.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $234.42 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $123.03 / $1,318.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $794.33 / $1,348.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $1,412.54 / $5,011.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $977.24 / $2,089.30