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Washington 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
$0.98 / $4.41 / $67.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.11 / $3.34
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $1.11 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $1.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.71 / $1.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.93
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.99 / $1.88
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $1.39 / $1.39
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.84 / $1.68
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.91