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Tennessee 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
$722.29 / $771.86 / $1,264.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.61 / $686.88 / $786.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.09 / $779.76 / $1,186.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.96 / $818.96 / $818.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.09 / $455.09 / $455.09
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.64 / $4,977.89 / $7,755.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.32 / $841.06 / $1,347.81