HCPCS S4025

Donor services for in vitro fertilization (sperm or embryo), case rate

Current code3 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

Prices for HCPCS S4025 by hospital
Hospital	Medicaid managed care rates (lowest – highest)	Cash price	List price (before discounts)
Island HospitalAnacortes	$290 – $3153 plans	—	—
Olympic Medical CenterPort AngelesFile dated 2026-06-24	$360 – $3945 plans	—	—
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01	—	—	—

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.