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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
$134.90 / $144.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $47.86 / $48.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $58.88 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $50.12 / $50.12
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $60.26
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $144.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $48.98 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $48.98 / $70.79