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South Dakota 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
$15.47 / $107.50 / $148.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.76 / $0.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.24 / $90.30 / $254.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.90 / $1.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.88 / $2.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.84 / $1.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.77 / $0.82 / $0.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.85
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90