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South Carolina 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
$72.31 / $4,230.00 / $9,870.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.39 / $155.84 / $263.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $93.73 / $93.73
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.54 / $105.70 / $183.02