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Vermont 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
$173.78 / $173.78 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $89.13 / $169.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $131.83 / $141.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $47.86 / $295.12