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Illinois rates for HCPCS J2791

Injection, Rho D immune globulin (human), (Rhophylac), intramuscular or intravenous, 100 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $107.15 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $12.30 / $138.04
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $5.50 / $7.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $18.62 / $61.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $8.71 / $100.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.31 / $6.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $8.13 / $8.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $5.25