go back

Montana 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
Professional
Modifier
Low / Median / High Price
$23.99 / $28.84 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $45.71 / $45.71
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $39.81 / $95.50
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $39.81 / $95.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $79.43 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $31.62