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Idaho rates for HCPCS Q2009

Injection, fosphenytoin, 50 mg phenytoin equivalent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.79 / $2.79 / $2.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $2.62 / $2.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.62 / $2.62 / $2.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $2.62 / $2.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.62 / $2.81 / $6.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $4.13 / $4.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $4.61 / $7.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $2.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $2.57 / $2.57