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Texas rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.60 / $104.45 / $324.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.60 / $135.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.12 / $491.32 / $970.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.74 / $86.74 / $86.74
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.32 / $97.07 / $218.41
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.68 / $367.35 / $367.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.65 / $85.80 / $97.07
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.86 / $72.80 / $109.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.57 / $60.00 / $85.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $74.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.04 / $41.04 / $97.07