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South Dakota rates for HCPCS 86653

Antibody; encephalitis, St. Louis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.40 / $12.40 / $12.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.84 / $12.40 / $12.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.11 / $26.11 / $26.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.28 / $24.15 / $30.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.64 / $21.16 / $119.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.43 / $11.87 / $21.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.45 / $26.86 / $41.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.45 / $22.13 / $35.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.47 / $30.80 / $36.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.54 / $7.91 / $18.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.19 / $13.19 / $13.19