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Oregon 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
$60.48 / $125.01 / $598.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $97.07 / $146.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.61 / $58.07 / $171.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $65.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $210.02 / $246.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.32 / $85.80 / $129.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.50 / $63.60 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $90.00 / $180.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.61 / $81.34 / $129.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.52 / $60.00 / $70.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.19 / $92.19 / $229.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00