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Louisiana rates for HCPCS 90396

Varicella-zoster immune globulin, human, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,344.23 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,630.27 / $2,884.03