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Hawaii rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.69 / $0.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.54 / $0.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.56 / $0.68
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.56 / $0.76