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Alaska rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $1.21 / $55.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.84 / $1.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $1.45
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $1.43 / $2.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $1.43 / $3.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.68 / $0.91