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Michigan 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
$1.39 / $5.96 / $21.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.96 / $2.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.92 / $1.72 / $3.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.95
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $5.33 / $21.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.90 / $2.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.87 / $1.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $0.98