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Montana rates for HCPCS G0455

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

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.89 / $109.89 / $206.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.76 / $108.50 / $169.20