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Indiana 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
$4.90 / $338.84 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $4.90 / $199.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $5.13 / $7.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $7.24 / $11.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $9.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $7.24 / $9.77
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 / $13.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $6.46