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Texas 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
$1.60 / $6.36 / $42.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $1.75 / $3.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.39
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.45 / $13.98
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.22 / $1.50
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $12.83 / $40.02
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $0.76 / $1.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.76 / $1.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.76 / $1.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $0.85
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $1.03