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Vermont rates for HCPCS 86695

Antibody; herpes simplex, type 1

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $91.20 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.02 / $22.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $102.33 / $223.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $109.65 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $15.14 / $20.89
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.57 / $4.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $11.48 / $35.48