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Maine 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
Professional
Modifier
Low / Median / High Price
$81.28 / $104.71 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $33.11 / $38.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $131.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $14.79 / $18.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $104.71 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $14.79 / $257.04