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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)  (Desc Rvsd 7/1/23)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.65 / $477.65 / $559.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.65 / $534.75 / $693.28
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,823.04 / $1,823.04 / $1,823.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.39 / $786.51 / $1,300.90