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Maine 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
$6.31 / $169.82 / $707.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.01 / $30.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $14.79 / $14.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $5.89
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $12.02 / $707.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $5.25 / $13.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $7.24