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Alaska 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
$31.62 / $269.15 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $4.90 / $9.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $269.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $15.49
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $17.38 / $26.92
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $8.91 / $12.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $5.25 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $7.24 / $977.24