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Louisiana rates for HCPCS G0455

Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.70 / $1,273.00 / $3,500.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.63 / $746.94 / $1,853.28
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.64 / $155.30 / $155.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $93.73 / $93.73