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Kentucky 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
$4.78 / $36.93 / $108.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $5.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.41 / $5.64 / $5.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $4.78 / $4.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $5.26 / $7.65
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $5.01 / $6.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $4.78 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $5.29 / $12.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $5.12