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North Carolina 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
$25.28 / $25.28 / $25.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.12 / $25.28 / $25.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.01 / $66.05 / $82.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.34 / $36.34 / $45.43
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.43 / $21.49 / $31.60
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.54 / $31.60 / $31.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.27 / $15.80 / $31.60
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $150.10 / $150.10