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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
$83.18 / $478.63 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $537.03 / $1,071.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $5,623.41 / $10,964.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $630.96 / $1,348.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $794.33 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $1,348.96 / $5,011.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $891.25 / $1,348.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $199.53 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,754.23 / $3,467.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $1,348.96 / $1,949.84