go back

Virginia 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
$22.91 / $60.26 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $23.99 / $30.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $165.96 / $194.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $19.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $77.62 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $36.31 / $45.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $38.02 / $46.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $16.60 / $31.62
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $36.31 / $79.43
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $36.31 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $31.62 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $14.13 / $23.44