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Maine rates for HCPCS 86695

Antibody; herpes simplex, type 1

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $53.70 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.02 / $109.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $123.03 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $7.94 / $16.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $18.62 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $15.14 / $19.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $13.18 / $15.85
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $56.23 / $131.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $13.18 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $13.18 / $26.92