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New Jersey 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
$831.76 / $831.76 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $741.31 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,548.82 / $1,621.81
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $5,888.44 / $9,549.93
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $812.83 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $7,244.36 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $758.58 / $1,548.82