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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
$478.63 / $478.63 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $537.03 / $891.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $74.13 / $83.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $6,309.57 / $8,511.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $56.23 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $776.25 / $1,288.25