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Washington rates for HCPCS 90396

Varicella-Zoster Immune Globulin Human Im

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,326.37 / $2,326.37 / $2,326.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.37 / $2,326.37 / $2,326.37
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,252.21 / $3,378.32 / $6,981.85
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.70 / $2,463.21 / $2,736.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,554.44 / $5,108.89 / $6,753.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,554.44 / $2,554.44 / $2,554.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.40 / $203.47 / $780.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,007.80 / $3,722.32 / $6,316.66
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,121.44 / $2,488.13 / $2,750.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,252.21 / $2,702.65 / $5,014.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,463.21 / $2,463.21 / $2,463.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,349.17 / $2,654.57 / $2,819.02