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Ohio 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
$122.52 / $2,547.00 / $10,268.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.37 / $70.45 / $79.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $93.73 / $93.73
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $93.73 / $93.73