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Vermont rates for HCPCS J1165

Injection Phenytoin Sodium Per 50 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $1.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $0.51 / $0.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.59 / $0.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.59 / $0.98
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.69