go back

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
$831.91 / $831.91 / $831.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.16 / $777.99 / $905.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.89 / $1,297.11 / $1,357.55
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,024.24 / $4,447.22 / $8,481.31
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.84 / $788.05 / $828.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.66 / $803.97 / $1,640.22