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Montana rates for HCPCS 90396

Varicella-Zoster Immune Globulin Human Im

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.39 / $310.39 / $310.39
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
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.94 / $161.94 / $161.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.94 / $2,554.44 / $2,554.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.94 / $161.94 / $161.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.09 / $149.36 / $2,554.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,654.57 / $2,654.57 / $2,819.02