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South Carolina rates for HCPCS 90396

Varicella-Zoster Immune Globulin Human Im

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,808.94 / $2,326.37 / $2,326.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,226.21 / $2,326.37 / $2,326.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.00 / $234.99 / $2,409.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,408.48 / $2,736.91 / $3,284.29
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,326.37 / $2,736.91 / $3,140.60
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,429.70 / $3,429.70 / $3,429.70
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 / $2,701.56 / $2,819.02