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New Hampshire rates for HCPCS 90396

Varicella-zoster immune globulin, human, for intramuscular use

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
$156.24 / $482.57 / $4,105.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,280.76 / $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
$2,440.83 / $3,778.02 / $7,180.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,349.17 / $2,349.17 / $2,736.91
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.66 / $2,350.92 / $3,606.11