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Kansas 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
$26.91 / $99.01 / $427.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $64.80 / $85.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.35 / $47.74 / $81.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $64.86 / $64.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.61 / $56.61 / $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
$47.40 / $85.89 / $147.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.75 / $97.07 / $107.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $98.81