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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
$33.88 / $45.71 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $25.12 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $45.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $28.18 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $15.85 / $34.67