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Virginia 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 / $5,699.61
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
$110.41 / $232.97 / $375.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,189.53 / $2,189.53 / $2,189.53
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.51 / $145.08 / $148.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.75 / $2,736.91 / $3,543.06
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,444.25 / $2,600.06 / $3,357.27
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,444.25 / $2,600.06 / $3,357.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,566.15 / $8,566.15 / $8,566.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,349.17 / $2,736.91 / $2,873.76