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Pennsylvania 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
$131.83 / $223.87 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $91.20 / $323.59
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $5,011.87 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $91.20 / $91.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $53.70 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $131.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $20.42 / $50.12
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $194.98 / $239.88
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $223.87 / $501.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $316.23
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $141.25 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $26.92 / $38.02