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
$1,453.06 / $1,453.06 / $1,453.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.82 / $45.82 / $45.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.34 / $45.43 / $45.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.82 / $45.82 / $45.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.60 / $37.92 / $45.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.27 / $13.27 / $31.60