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Texas 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
$20.42 / $47.86 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $23.99 / $33.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $24.55 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $38.02 / $47.86
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $31.62 / $58.88
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $25.70 / $36.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $23.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $31.62 / $79.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $31.62 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $14.79 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $31.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80