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Massachusetts 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
$21.88 / $70.79 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $23.99 / $30.20
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $24.55 / $51.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $38.02 / $47.86
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $53.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $60.26
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $47.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $31.62 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $19.05 / $47.86