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Pennsylvania rates for HCPCS J2792

Injection Rho D Immune Globulin Intravenous Human Solvent Detergent 100 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.99 / $72.00 / $93.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $25.71 / $95.29
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.48 / $27.62 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.42 / $26.42 / $26.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.02 / $25.46 / $25.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $25.46 / $25.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.08 / $61.23 / $93.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $31.08 / $93.54
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.02 / $25.46 / $25.46
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $25.46 / $25.46
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.92 / $32.92 / $38.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.92 / $32.92 / $38.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $28.52 / $43.81