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Utah rates for HCPCS J1240

Injection, dimenhydrinate, up to 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $12.02 / $13.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.91
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $7.94 / $8.51
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $6.17 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.91