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New Jersey 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
$40.74 / $41.69 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $25.12 / $41.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $38.02 / $47.86
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $14.79 / $18.62
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $11,481.54 / $25,703.96
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $31.62 / $64.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $19.05 / $32.36