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Utah rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.59 / $69.59 / $112.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.59 / $69.59 / $69.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.00 / $62.32 / $122.39
Cigna
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