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Maine 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
$31.62 / $31.62 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $23.99 / $30.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $15.14 / $20.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $45.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $31.62 / $38.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $25.12 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $19.05 / $45.71