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South Dakota rates for HCPCS 86363

Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $42.66 / $933.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $28.18 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $72.44 / $91.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $42.66 / $177.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $38.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $87.10 / $104.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $10.96 / $38.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02