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Indiana rates for HCPCS J0694

Injection Cefoxitin Sodium 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.84 / $65.14 / $230.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.83 / $5.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $9.56 / $14.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $4.78 / $6.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $4.78 / $6.45
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $5.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $12.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $8.13