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Montana rates for HCPCS Q2009

Injection, fosphenytoin, 50 mg phenytoin equivalent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.02 / $25.02 / $25.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $2.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.21 / $4.21 / $9.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $2.62 / $4.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.21 / $4.21 / $9.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $3.88 / $5.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $2.57 / $2.57