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Maine rates for HCPCS 90396

Varicella-Zoster Immune Globulin Human Im

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.37 / $2,326.37 / $2,326.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.84 / $136.99 / $2,312.69
Anthem BCBS
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.37 / $2,691.61 / $4,129.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.37 / $2,326.37 / $2,326.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,996.80 / $2,349.17 / $3,523.77