Rho(D) immune globulin, 1500 IU dose at Samaritan Hospital

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

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Generated: October 20, 2026

Original text from hospital filings

PR Rho D Immune Globulin Rhophylac Im/IV Injection 100 Iu

Troy, NY

See all hospitals reporting HCPCS J2791 →

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How this price compares nationally

Samaritan Hospital’s median price of $159 is 372% above the median hospital's median price ($34), higher than 71% of the 1,854 hospitals reporting HCPCS J2791. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS J2791 at Samaritan Hospital

Negotiated rates from the hospital’s own file: 34 payers, 97 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Humana tricare professional · fee schedule · outpatient	$5	$5	—	—	1–10	$5 – $5
2	Tricare tricare professional · fee schedule · outpatient	$5	$5	—	—	—	$5 – $5
3	UnitedHealthcare united healthcare medicaid harp chip facility · fee schedule · both	$50	$50	—	—	—	$50 – $50
4	Humana tricare professional · fee schedule · inpatient	$70	$70	—	—	—	$70 – $70
5	Tricare tricare professional · fee schedule · inpatient	$70	$70	—	—	—	$70 – $70
6	Anthem empire medicaid facility · fee schedule · both	$72	$72	—	—	—	$72 – $72
7	Anthem empire medicaid essential 1 2 3 4 facility · fee schedule · both	$72	$72	—	—	—	$72 – $72
8	Excellus empire medicaid facility · fee schedule · both	$72	$72	—	—	—	$72 – $72
9	Excellus empire medicaid essential 1 2 3 4 facility · fee schedule · both	$72	$72	—	—	—	$72 – $72
10	Cigna cigna facility · fee schedule · both	$109	$109	—	—	—	$109 – $109
11	UnitedHealthcare united healthcare facility · fee schedule · both	$123	$123	—	—	—	$123 – $123
12	First Health first health facility · percent of total billed charges · bothfrom % of charges	$142	$142	—	—	—	$142 – $142
13	Aetna pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
14	Ambetter pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
15	Amerihealth Caritas pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
16	Anthem pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	2–20	$152 – $152
17	Blue Cross Blue Shield pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	4–40	$152 – $152
18	Carefirst pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
19	Caresource pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
20	Cigna pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	1–10	$152 – $152
21	Clover pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
22	Devoted pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
23	Excellus pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
24	First Health pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	—	$152 – $152
25	Highmark pb xr 100% default professional · percent of total billed charges · outpatientfrom % of charges	$152	$152	—	—	1–10	$152 – $152

Page 1 of 4 · 97 rates

Last updated: Mar 31, 2026

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