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Nebraska 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
$4.79 / $9.55 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $120.23 / $181.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $6.17 / $7.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $5.50 / $5.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $5.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $5.37 / $5.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.90 / $6.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $10.72 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $5.01 / $7.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $7.59 / $7.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.90 / $12.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $4.79 / $7.24