go back

South Dakota rates for HCPCS 86695

Antibody; herpes simplex, type 1

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $77.62 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.02 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $25.70 / $31.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $20.42 / $77.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.94 / $18.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $30.90 / $36.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $9.33 / $21.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18