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Idaho 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
$57.64 / $57.64 / $82.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.12 / $61.62 / $61.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.24 / $123.24 / $123.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.01 / $36.34 / $45.43
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.02 / $61.62 / $65.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.60 / $31.60 / $37.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $55.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.40 / $63.20 / $113.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.86 / $47.26 / $48.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.27 / $13.27 / $37.92