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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $776.25 / $1,258.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $707.95 / $933.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $7,762.47 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,380.38