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Florida 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 / $1.32 / $222.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.45 / $0.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.87
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.79
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.66