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Louisiana 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 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $630.96 / $933.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $74.13 / $83.18
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $3,311.31 / $5,754.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $794.33 / $1,230.27