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North Carolina rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.77 / $0.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.45 / $0.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.66
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 / $1.02
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.54 / $1.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.71
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 / $0.59
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00