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Idaho rates for HCPCS J1180

Injection Dyphylline Up To 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.49 / $9.49 / $9.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $8.07 / $9.49
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.65 / $11.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.49 / $9.49 / $10.95