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Sperm Readiness Test For Male Fertility

North Carolina rates for HCPCS 0255U

Assesses male fertility by examining sperm under a microscope and scoring how many have completed capacitation — the change that makes a sperm able to fertilize an egg. The marker used is ganglioside GM1 on the sperm surface, and the result is reported as a likelihood.

Rates data updated July 2026.

How much does Sperm Readiness Test For Male Fertility cost?

$25.12

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $25.12 for this service. The price depends on where it is billed: about $25.12 from a physician practice, and about $25.12 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$25.12$22.91 to $25.12
FacilityA hospital or hospital-owned outpatient department$25.12$25.12 to $43.65

How much rates vary

Facilitymedian $25 · 10th to 90th $17 to $151Professionalmedian $25 · 10th to 90th $19 to $25
$20$50$100facility $25professional $25

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$25.12
Typical High
$69.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$25.12
Typical High
$25.12
BCBS
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$100.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$28.18
Typical High
$31.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$83.18
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$38.02
Typical High
$47.86
Medcost
Setting
Facility
Modifier
Global
Typical Low
$16.60
Median
$23.44
Typical High
$33.11
Medcost
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$20.42
Typical High
$23.44
United
Setting
Facility
Modifier
Global
Typical Low
$15.85
Median
$31.62
Typical High
$38.02
United
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$15.85
Typical High
$31.62
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36

Where North Carolina sits

The same service costs 3.2 times more in South Dakota than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

North Carolina· 36th of 51

$25.12

SD $60.26KY $19.05

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.