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Louisiana 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
$33.50 / $45.60 / $166.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.70 / $35.08 / $41.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.54 / $222.58 / $239.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.34 / $36.34 / $45.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.64 / $15.80 / $47.40