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Indiana rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $116.76 / $210.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.70 / $46.70 / $46.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.08 / $97.30 / $145.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.72 / $50.26 / $71.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.88 / $20.88 / $27.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.88 / $20.88 / $33.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.62 / $49.62 / $49.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.26 / $49.62 / $136.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.65 / $48.65 / $64.98