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Virginia 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
$5.75 / $257.04 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.01 / $83.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $8.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $7.76 / $11.75
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $4.79 / $13.49
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $8.51 / $9.12
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $5.89 / $11.75
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $5.89 / $11.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $4.79 / $6.03