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Wisconsin rates for HCPCS 86695

Antibody; herpes simplex, type 1

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $70.79 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $11.75 / $29.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $35.48 / $36.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $6.46 / $52.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.47 / $36.31 / $37.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $41.69 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $19.05 / $40.74
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $28.84 / $104.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.47 / $15.85 / $134.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $10.96 / $30.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $32.36 / $64.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $33.88 / $77.62
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $28.18 / $81.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $8.71 / $12.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $26.92 / $28.18
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $47.86 / $81.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $11.75 / $15.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $10.72 / $32.36