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Wisconsin rates for HCPCS G0455

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

Facilitymedian $117 · 10th–90th $63$7410%10%10th90th$117Professionalmedian $204 · 10th–90th $107$4470%10%10th90th$204$50.0$200.0$1.0K$5.0K

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
$63.10 / $741.31 / $1,905.46
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $407.38 / $660.69
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $109.65 / $165.96
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $109.65 / $186.21
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $204.17 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $245.47 / $436.52
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $478.63
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $2,454.71 / $3,235.94