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Louisiana rates for HCPCS G0460

Autologous platelet rich plasma (PRP) or other blood-derived product for nondiabetic chronic wounds/ulcers (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
$89.24 / $101.64 / $163.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.24 / $141.78 / $748.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$939.91 / $1,762.13 / $3,899.77
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.12 / $117.12 / $117.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.63 / $803.63 / $803.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.95 / $630.72 / $630.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.42 / $184.37 / $404.81