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Rhode Island 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
$9.50 / $15.54 / $64.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $5.13 / $7.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $4.78 / $4.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $11.91