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South Dakota rates for HCPCS 86694

Antibody; herpes simplex, non-specific type test

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $61.66 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $12.88 / $22.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $27.54 / $27.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $27.54 / $34.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $22.39 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $10.00 / $19.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $34.67 / $39.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $10.00 / $25.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $14.45 / $14.45