go back

New York 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
$102.51 / $3,000.00 / $7,839.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,651.00 / $3,263.00 / $4,636.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.90 / $100.90 / $100.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $93.73 / $93.73
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.34 / $178.52 / $332.00
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.03 / $122.03 / $122.03
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $93.73 / $597.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.42 / $75.42 / $75.42