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New Mexico 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
$5.25 / $239.88 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.01 / $181.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.23 / $26.30 / $42.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
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 / $4.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $5.89 / $9.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.90