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Fecal Microbiota Preparation and Instillation

Ohio rates for HCPCS G0455

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

Rates data updated July 2026.

Facilitymedian $3,162 · 10th–90th $120$12,0230%5%10%10th90th$3,162$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$3,162.28
Typical High
$12,022.64
CareSource
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$70.79
Typical High
$87.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$2,137.96
Typical High
$2,884.03