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Pennsylvania rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $1.54 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $1.31
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.49 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.47
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $1.69 / $38.50
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $1.34 / $2.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.66 / $2.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.45 / $0.45
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.65
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.81