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Montana 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 / $89.13 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $131.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $162.18 / $173.78
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $162.18 / $173.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $85.11