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Nebraska 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
$1.24 / $33.20 / $145.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.37 / $2.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $0.82 / $0.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.86 / $1.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.03 / $1.03 / $1.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.76 / $0.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.94 / $28.13 / $77.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.90 / $1.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.77 / $0.84 / $1.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.95 / $1.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.90