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Massachusetts rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.63 / $31.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.47 / $0.79
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $1.38 / $75.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $1.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.57 / $1.22
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $83.43 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.95
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $1.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $1.10