go back

Ohio 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
$29.51 / $44.67 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $25.12 / $37.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $5.50 / $33.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $501.19 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $36.31 / $45.71
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $20.42 / $181.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $33.11 / $63.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $20.42 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $31.62