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Wisconsin rates for HCPCS J2791

Rhophylac Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $168.92 / $453.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $12.39 / $255.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.08 / $6.08 / $6.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $6.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.65 / $6.65 / $7.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.86 / $11.62 / $16.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.99 / $7.54 / $8.56
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $4.97 / $8.83
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.74 / $9.72 / $9.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $4.97 / $15.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.97 / $4.97 / $9.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $4.97 / $8.83
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.74 / $9.72 / $9.72
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.84 / $7.56 / $15.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.86 / $4.86 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $4.86
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.04 / $6.82 / $7.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $7.29