go back

Arizona rates for HCPCS 0255U

Andrology (infertility), sperm-capacitation assessment of ganglioside GM1 distribution patterns, fluorescence microscopy, fresh or frozen specimen, reported as percentage of capacitated sperm and probability of generating a pregnancy score

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $63.10 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $23.99 / $30.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $57.54 / $85.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $26.92 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $24.55 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $38.02 / $47.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $23.44 / $151.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $31.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $31.62 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $25.12