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Illinois rates for HCPCS J1110

Injection Dihydroergotamine Mesylate Per 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.59 / $106.10 / $871.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $62.40 / $117.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.78 / $480.65 / $1,238.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.94 / $72.00 / $283.25
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $80.22