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New York rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.41 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.74 / $1.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.56 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $1.91
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.52 / $1.45
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.46 / $0.78
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.47
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.47
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $50,118.72 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.60 / $0.93
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.54
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.45 / $0.54