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Idaho rates for HCPCS 90396

Varicella-zoster immune globulin, human, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,924.98 / $3,924.98 / $3,924.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.37 / $2,326.37 / $2,326.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,554.44 / $2,554.44 / $2,554.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,554.44 / $2,554.44 / $2,554.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,326.37 / $2,465.94 / $3,326.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,252.21 / $3,378.32 / $5,743.14
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,010.60 / $3,010.60 / $3,079.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,654.57 / $2,654.57 / $2,819.02