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Utah 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
$81.28 / $446.68 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $131.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $97.72 / $213.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $34.67 / $34.67
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $53.70 / $53.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67