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South Dakota rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $1.11 / $1.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.66 / $0.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.62 / $0.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.63 / $0.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.50
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66