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Arizona rates for HCPCS 89261

Sperm isolation; complex prep (eg, Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.18 / $166.18 / $190.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.51 / $106.73 / $296.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $242.38 / $403.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.80 / $92.80 / $132.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.60 / $90.61 / $146.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.73 / $105.73 / $132.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.22 / $90.98 / $128.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.50 / $195.00 / $195.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.00 / $195.00 / $195.00