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Utah 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
$28.18 / $151.36 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $25.12 / $33.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $27.54 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $45.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.02 / $147.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $26.92 / $28.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $31.62 / $31.62
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $27.54 / $47.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $20.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $25.12