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Pennsylvania 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
$1.71 / $3.75 / $14.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.41 / $3.34
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $1.14 / $126.19
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.69 / $0.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $0.82 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.78 / $0.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.76 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.52 / $5.20 / $10.76
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $1.12 / $121.16
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.69 / $0.69
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.40 / $4.54 / $36.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.42 / $3.34
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.76 / $0.76
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.15 / $1.35
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.15 / $1.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.84 / $1.39