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Michigan 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
$5.01 / $123.03 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.01 / $128.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $4.90 / $6.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $10.72 / $21.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.57 / $4.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $72.44 / $239.88
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.37 / $16.22
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $8.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $5.13