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Nebraska 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
$0.66 / $0.86 / $1.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.66 / $1.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.49 / $0.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.51 / $0.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.53 / $0.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.57 / $1.41 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.66 / $0.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.63 / $0.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.72 / $1.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.45 / $0.50