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Arizona rates for HCPCS J0720

Injection Chloramphenicol Sodium Succinate Up To 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.69 / $86.54 / $175.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.29 / $56.75 / $85.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $173.58 / $274.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.11 / $46.70 / $309.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.62 / $49.62 / $49.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.62 / $49.62 / $49.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.94 / $52.02 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.65 / $48.65 / $48.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.65 / $48.65 / $48.65