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Pennsylvania rates for HCPCS J1240

Injection, dimenhydrinate, up to 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.20 / $14.64 / $31.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.14 / $6.20 / $17.19
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.66 / $6.66 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.37 / $6.37 / $6.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.79 / $6.14 / $6.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.14 / $6.14 / $6.14
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $5.98 / $14.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.14 / $11.73 / $23.53
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.14 / $7.82 / $23.53
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.79 / $6.14 / $6.14
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.14 / $6.14 / $6.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.18 / $8.18 / $9.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.18 / $8.18 / $9.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.14 / $6.14 / $10.58