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Louisiana rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $58.88 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $58.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $53.70
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $70.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $53.70