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New Hampshire 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
$4.79 / $6.17 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $4.79 / $13.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $10.00 / $17.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $5.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $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 / $8.13 / $9.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $7.41