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Rhode Island rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $1.46 / $1.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.90