go back

Montana rates for HCPCS 86695

Antibody; herpes simplex, type 1

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $81.28 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $12.02 / $36.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $45.71 / $91,201.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $17.78 / $17.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $22.39 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $15.14 / $19.05
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $18.62 / $40.74
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $18.62 / $40.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $22.39 / $75.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $19.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.75 / $18.20