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Montana 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
$81.28 / $81.28 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.94 / $181.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.51 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $5.62 / $14.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $5.62
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $5.13 / $14.79
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.13 / $14.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $5.62 / $14.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $6.92 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79