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New Hampshire 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 / $0.74 / $1.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.68 / $1.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.45 / $0.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $0.75 / $1.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.22 / $1.77