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Texas rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.94 / $98.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.46 / $1.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.81 / $1.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.66 / $0.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.50 / $0.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.45 / $0.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.66