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Indiana 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
$36.31 / $48.98 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.12 / $30.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $95.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $23.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $457.09 / $43,651.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $36.31 / $45.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $31.62 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $31.62