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Pennsylvania rates for HCPCS 86695

Antibody; herpes simplex, type 1

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.91 / $57.06 / $98.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.75 / $11.88 / $23.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.91 / $7.91 / $13.19
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.73 / $63.59 / $1,008.11
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.48 / $86.33 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.29 / $10.29 / $10.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.13 / $17.55 / $43.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.23 / $15.28 / $23.27
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.07 / $7.78 / $17.86
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.80 / $35.04 / $69.83
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.91 / $12.50 / $13.75
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.17 / $60.12 / $140.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.02 / $56.45 / $128.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.89 / $11.88 / $29.65
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.27 / $146.97 / $204.47
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.83 / $20.03 / $43.46
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.23 / $15.28 / $23.27
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.19 / $13.19 / $13.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.61 / $13.19 / $18.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.87 / $15.83 / $15.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.54 / $7.91 / $23.10