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South Carolina 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
$0.40 / $0.48 / $2.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.48 / $1.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $1.48 / $28.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.45 / $0.62
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 / $0.45
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.65 / $1.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45