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Hawaii rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.98 / $71.98 / $71.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.98 / $71.98 / $71.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.62 / $49.62 / $49.62
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.03 / $60.03 / $60.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.54 / $48.65 / $72.98
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.22 / $41.26 / $51.58