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Michigan rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $128.82 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $46.77 / $57.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $79.43 / $162.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $38.02 / $38.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $128.82 / $165.96
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $61.66 / $85.11
Priority Health
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 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $51.29