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New York 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 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $13.49 / $181.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.68 / $4.68 / $4.90
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $4.68 / $4.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.57 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $20.42
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $5.89 / $16.60
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $8.91
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $4.90 / $5.13
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $5.01
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $11.22 / $19.50
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $5.62 / $5.62
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $50,118.72 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $8.51
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $4.90 / $5.75
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $5.01 / $5.89