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Ohio rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.98 / $1.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.53 / $1.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $1.05 / $2.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $1.37
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $1.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.65 / $0.92
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