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Indiana 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
$477.89 / $477.89 / $477.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.89 / $501.78 / $894.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.30 / $17.30 / $33.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.30 / $56.24 / $199.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.92 / $797.50 / $1,282.89