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Wisconsin 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
$77.62 / $89.13 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $104.71 / $346.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $51.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $269.15 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $131.83 / $158.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $91.20 / $104.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $91.20 / $138.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $85.11 / $616.60
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $33.11 / $194.98