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Washington rates for HCPCS G0455

Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen

Facilitymedian $200 · 10th–90th $76$6,6070%5%10th90th$200$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $2,818.38 / $18,620.87
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,454.71 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $158.49 / $389.05
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $245.47 / $257.04
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $177.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,511.89 / $4,897.79
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $3,467.37 / $6,309.57