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Indiana 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
$0.46 / $1.06 / $2.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $0.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.90 / $1.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.45 / $0.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.59
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 / $1.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.77