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North Carolina 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
$5.75 / $229.09 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.94 / $144.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $7.76 / $10.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $5.25
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 / $12.30
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $5.75 / $5.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $8.13 / $9.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $7.41
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00