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Illinois 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
$89.13 / $138.04 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $363.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $2,630.27 / $8,128.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $83.18 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $107.15 / $134.90
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $338.84 / $1,122.02
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $102.33 / $141.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $104.71