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Arizona rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.90 / $1.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.80 / $1.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $1.74 / $2.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.64 / $2.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $1.03 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45