go back

Iowa 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
$0.89 / $0.89 / $2.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.89 / $1.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.59 / $0.66
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.81 / $2.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.89 / $1.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.66 / $1.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.63 / $1.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.67 / $1.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.50
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66