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Illinois 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
$46.70 / $93.40 / $156.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.70 / $46.70 / $58.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.20 / $98.63 / $510.15
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.83 / $53.30 / $120.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.65 / $48.65 / $52.54