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New Mexico rates for HCPCS 90396

Varicella-zoster immune globulin, human, for intramuscular use

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $2,754.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,754.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $707.95 / $1,148.15
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $151.36 / $5,370.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,818.38 / $2,884.03