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Pennsylvania 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
$39.81 / $81.28 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $25.12 / $36.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $24.55 / $24.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $47.86 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $45.71
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $18.62 / $45.71
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $31.62 / $54.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $81.28 / $138.04
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.70 / $112.20
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $33.88
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $33.88 / $162.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $31.62 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $47.86