go back

South Dakota rates for HCPCS 86756

Antibody Respiratory Synctial Virus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.94 / $14.94 / $14.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.65 / $15.41 / $23.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.99 / $31.99 / $31.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.17 / $28.72 / $35.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.23 / $20.67 / $75.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.43 / $14.30 / $21.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.45 / $29.12 / $47.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.45 / $26.67 / $41.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.47 / $37.10 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.67 / $9.52 / $19.07
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.89 / $15.89 / $15.89