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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
$28.79 / $48.35 / $126.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.17 / $21.17 / $126.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.68 / $69.55 / $115.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.30 / $26.62 / $37.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.36 / $49.30 / $88.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.34 / $38.40 / $48.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.43 / $23.38 / $150.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.27 / $13.27 / $25.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.27 / $13.27 / $25.28