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Louisiana 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
$0.93 / $7.58 / $40.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.80 / $1.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.74
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.15