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Pennsylvania rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $132.29 / $295.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.60 / $146.63
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.34 / $65.09 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.27 / $62.27 / $62.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.61 / $60.00 / $60.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.08 / $113.79 / $303.06
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.04 / $149.49 / $295.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $98.04 / $295.08
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.61 / $60.00 / $60.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.32 / $57.32 / $66.51
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.32 / $57.32 / $66.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $85.71