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Wisconsin 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
$2.43 / $34.65 / $76.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.17 / $3.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $0.95 / $0.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $1.79 / $2.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $1.24 / $1.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.90 / $1.42
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $1.52 / $1.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $33.18 / $59.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.00 / $1.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.90 / $1.42
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $1.52 / $1.52
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.02 / $2.16
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.07 / $1.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.85 / $1.12