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Maine rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.44 / $135.44 / $145.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.62 / $49.62 / $49.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.41 / $150.41 / $150.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.62 / $49.62 / $49.62
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.26 / $50.26 / $60.86
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.44 / $135.44 / $145.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.62 / $49.62 / $145.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.50 / $48.65 / $70.54