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Missouri 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 / $169.82 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $12.30 / $125.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $8.13 / $12.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.90 / $6.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.79 / $4.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $5.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $12.59 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $5.01 / $6.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $6.46 / $7.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.79 / $6.03