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Texas 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
$424.00 / $2,128.00 / $7,316.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.44 / $1,233.89 / $2,664.27
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.64 / $155.30 / $155.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $93.73 / $93.73
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.79 / $361.79 / $361.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.32 / $107.37 / $183.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.32 / $107.37 / $196.91