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Montana 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
$4.62 / $21.60 / $74.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.13 / $2.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.75 / $2.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.76 / $0.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.75 / $2.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.82 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76