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Pennsylvania 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
$7.24 / $194.98 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $8.71 / $181.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $5.25 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
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
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $8.32 / $8.32
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $31.62 / $74.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $194.98 / $1,202.26
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.31 / $158.49
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $5.75 / $7.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $5.75 / $7.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $8.91