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West Virginia 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
$10.89 / $33.18 / $82.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $5.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $5.13 / $7.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.08 / $11.08 / $11.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $4.78 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $12.33
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.95 / $9.72 / $26.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $10.87