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Michigan rates for HCPCS 90396

Varicella-zoster immune globulin, human, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,326.37 / $2,326.37 / $2,326.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.36 / $2,326.37 / $2,326.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,767.25 / $4,985.06 / $9,430.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,166.71 / $2,166.71 / $2,280.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.61 / $2,554.44 / $2,554.44
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,313.52 / $2,326.37 / $2,736.91
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,313.52 / $2,326.37 / $2,776.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,349.17 / $2,772.03 / $2,904.29