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Hawaii 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
$9.42 / $9.42 / $9.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $6.67 / $280.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.41 / $9.41 / $9.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $4.86 / $4.86
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.14 / $7.14 / $7.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.34 / $5.83 / $6.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.86 / $5.87 / $7.29
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $5.86 / $6.31