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South Dakota rates for HCPCS 86696

Antibody; herpes simplex, type 2

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $91.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $17.38 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $37.15 / $46.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $25.70 / $91.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $13.49 / $26.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $46.77 / $53.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $13.49 / $33.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $19.50 / $19.50