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Arizona rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.78 / $120.00 / $215.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.00 / $117.46 / $146.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.70 / $252.50 / $465.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.60 / $93.96 / $381.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.10 / $60.00 / $60.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.86 / $131.38 / $204.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.07 / $97.07 / $97.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00