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Texas rates for HCPCS Q2009

Injection, fosphenytoin, 50 mg phenytoin equivalent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.43 / $264.77 / $760.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $3.52 / $3.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.28 / $8.30 / $16.39
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.73 / $15.05
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.28 / $101.28 / $101.28
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $3.28 / $7.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.46 / $4.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.50 / $2.62 / $5.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $2.62 / $3.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.67 / $12.67 / $12.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $2.57 / $2.57
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.58 / $3.58 / $4.83