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Nebraska 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
$86.68 / $478.94 / $889.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.94 / $478.94 / $989.08
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
$323.75 / $340.80 / $344.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.63 / $627.49 / $1,335.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.09 / $793.87 / $2,707.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.28 / $1,354.61 / $2,151.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.01 / $627.49 / $1,335.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.01 / $900.03 / $1,335.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.76 / $1,467.49 / $1,846.03