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Pennsylvania 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
$147.22 / $2,240.00 / $7,629.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
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
$154.08 / $154.08 / $154.08
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $2,371.00 / $7,799.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.40 / $141.40 / $141.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $93.73 / $93.73
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.82 / $69.59 / $125.88