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Vermont 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
$2.73 / $7.16 / $70.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $1.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.85 / $0.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.75 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.75 / $1.25
MVP Health Care
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 / $0.81 / $1.17