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Virginia 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
$2.04 / $10.07 / $63.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $1.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.42 / $2.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.91 / $1.97
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $1.23 / $1.64
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.92 / $1.35
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.92 / $1.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.81 / $0.99