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Maine 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
$1.76 / $6.40 / $24.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.79 / $1.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.35 / $2.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Community Health Options
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.92
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.76 / $6.06 / $28.35
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.79 / $1.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.76 / $1.33