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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
$18.19 / $95.60 / $309.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.32 / $17.42 / $92.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.52 / $38.52 / $38.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.30 / $35.25 / $44.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.94 / $25.87 / $91.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.61 / $13.54 / $27.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.87 / $23.65 / $39.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.87 / $29.26 / $50.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.61 / $45.18 / $53.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $13.54 / $27.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.35 / $19.35 / $19.35