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Arizona 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
$8.51 / $95.50 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.31 / $186.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $12.59 / $19.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $9.33 / $22.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $7.76 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $8.13 / $8.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.90