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Maryland rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.07 / $135.22 / $454.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $130.07
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.01 / $60.01 / $97.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $76.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $90.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $97.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.04 / $41.04 / $41.04