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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
$25.28 / $54.35 / $97.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.28 / $25.28 / $25.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.41 / $4.41 / $23.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.46 / $42.66 / $844.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.14 / $69.31 / $877.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.56 / $35.95 / $182.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.34 / $36.34 / $45.43
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.56 / $20.54 / $182.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.27 / $18.96 / $37.92