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Nebraska rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $115.33 / $211.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $97.07 / $162.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.95 / $67.93 / $67.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.53 / $67.93 / $109.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $87.38 / $109.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.86 / $184.43 / $527.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.75 / $97.07 / $145.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.24 / $99.61 / $169.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.24 / $82.28 / $169.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.00 / $60.00 / $66.00