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New Hampshire 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
$79.43 / $79.43 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $21.88 / $25.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $60.26 / $181.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $20.42 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $100.00 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $45.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $54.95 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $31.62