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Indiana rates for HCPCS J2560

Injection Phenobarbital Sodium Up To 120 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.33 / $76.88 / $635.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.47 / $30.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.68 / $60.34 / $90.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.64 / $30.17 / $42.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.17 / $30.17 / $45.26
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $37.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $86.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $40.29