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Wisconsin 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
$5.01 / $316.23 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $14.45 / $190.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $6.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $10.00 / $17.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $6.17 / $8.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $4.90 / $8.91
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $9.77 / $9.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $5.01 / $15.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $9.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $5.25 / $15.14
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.61 / $8.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $7.76