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Michigan 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
$30.20 / $30.20 / $54.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.70 / $37.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $22.39 / $22.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $22.39 / $22.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $38.02 / $47.86
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $75.86
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $31.62 / $42.66
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $38.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $31.62 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $20.42