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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
$72.44 / $72.44 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $107.15 / $363.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $199.53 / $295.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $93.33 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $50.12 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $131.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $91.20 / $128.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $194.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $26.92 / $194.98