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Michigan rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.68 / $30.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.47 / $0.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.57 / $1.04 / $1.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.17 / $0.18 / $0.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $1.01 / $2.12
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.47 / $0.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.59 / $0.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.48