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Illinois 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
$32.36 / $52.48 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.70 / $36.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $42.66 / $51.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $58.88 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $38.02 / $47.86
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $44.67 / $151.36
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $31.62 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $31.62