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Montana rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.80 / $1.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.02 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $1.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $1.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.49 / $0.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45