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Arizona rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $102.33 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $47.86 / $56.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $134.90 / $199.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $93.33 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $52.48 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98