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Utah 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
$102.33 / $263.03 / $524.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.01 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $6.92 / $7.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $5.01 / $6.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.90 / $5.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79