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Wisconsin 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
$912.01 / $2,089.30 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $616.60 / $912.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,454.71 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,905.46 / $2,344.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $3,162.28 / $4,786.30
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $4,570.88 / $5,011.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $912.01 / $2,630.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $457.09 / $3,801.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $70.79 / $758.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,778.28 / $2,511.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,630.78 / $3,630.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $3,019.95 / $3,801.89
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $4,168.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $457.09 / $1,258.93