go back

Utah rates for HCPCS J1165

Injection, phenytoin sodium, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.66 / $1.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.71 / $0.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.44 / $1.07
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.45 / $0.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60