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Idaho 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
$1.60 / $6.82 / $63.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.09 / $2.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.76 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $4.86 / $32.06
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.07