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Washington 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 / $141.25 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.12 / $37.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $70.79 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $45.71
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $44.67
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $54.95 / $95.50
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $28.18 / $38.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $47.86 / $87.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $28.18 / $31.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $38.02 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $31.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.13 / $56.23