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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
$4.97 / $9.53 / $83.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $5.05 / $74.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $9.68
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.71 / $4.71 / $4.95
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.71 / $4.71 / $4.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.58 / $4.58 / $5.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $4.86
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.58 / $6.87 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $12.73
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.86 / $4.86 / $5.04
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $5.04
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.63 / $11.13 / $19.30
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.55 / $5.63
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.58 / $4.58 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.88 / $7.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $11.25
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.04 / $5.04 / $5.04
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $5.04 / $5.50