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Texas 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
$8.91 / $186.21 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $4.79 / $120.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $5.13 / $5.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $23.99 / $45.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $12.30 / $416.87
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.79 / $4.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $173.78 / $630.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.01 / $120.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $5.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $6.92 / $15.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $5.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79