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Virginia 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
$0.48 / $1.38 / $188.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.78 / $1.17
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.54 / $1.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.89 / $1.98
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.54 / $0.97
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.54 / $0.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.56