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New Hampshire rates for HCPCS 0254U

Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using embryonic DNA genomic sequence analysis for aneuploidy, and a mitochondrial DNA score in euploid embryos, results reported as normal (euploidy), monosomy, trisomy, or partial deletion/duplication, mosaicism, and segmental aneuploidy, per embryo tested

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $562.34 / $660.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,445.44 / $4,365.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,398.83 / $3,311.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,445.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $758.58