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Hawaii rates for HCPCS J1200

Injection Diphenhydramine Hcl Up To 50 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.07 / $22.88 / $31.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.32 / $3.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.34 / $2.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.91 / $1.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.88 / $1.13
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.90 / $1.45