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Montana rates for HCPCS J2792

Injection Rho D Immune Globulin Intravenous Human Solvent Detergent 100 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $31.08 / $95.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.10 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.11 / $37.11 / $87.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $25.46 / $37.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.11 / $37.11 / $87.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $27.62 / $41.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $25.46 / $25.46