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Texas rates for HCPCS J2791

Rhophylac Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.53 / $174.66 / $480.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.90 / $8.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.72 / $24.60 / $49.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.99 / $5.99 / $5.99
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.33 / $11.18 / $428.10
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.84 / $70.84 / $70.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.58 / $4.86 / $4.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $4.86
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $5.35 / $7.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.73 / $4.86 / $8.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.58 / $4.86 / $7.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.59 / $4.86 / $8.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $4.86
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $6.56