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South Dakota 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
$28.84 / $28.84 / $36.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $23.99 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $60.26 / $75.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $30.20 / $151.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $38.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $74.13 / $87.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $41.69
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62