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Oregon 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
$0.56 / $0.73 / $1.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.66 / $1.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.66 / $1.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $1.40 / $1.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.64 / $1.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.70
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.66 / $1.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.66 / $1.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.55 / $0.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45