go back

California rates for HCPCS J1165

Injection Phenytoin Sodium Per 50 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.99 / $1.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $1.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.59 / $0.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.66 / $1.86
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $0.87 / $1.20
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.46 / $1.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.54 / $1.04
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.45 / $0.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.97
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.50 / $0.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $1.23