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Connecticut 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
$0.47 / $0.85 / $1.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.80 / $1.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.49 / $0.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.45 / $1.19