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Utah 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
$5.36 / $21.34 / $59.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.52 / $2.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $0.97 / $1.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.76 / $0.85