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Wisconsin 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
$63.21 / $743.70 / $14,482.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.54 / $409.63 / $628.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.21 / $111.87 / $159.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.35 / $107.26 / $164.04
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.21 / $113.11 / $159.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.12 / $237.51 / $403.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.73 / $361.79 / $361.79