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Illinois rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.79 / $2.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.47 / $0.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $2.85 / $8.59
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.86 / $3.34
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.60