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Montana rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $47.86 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $50.12 / $50.12
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $39.81 / $40.74
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $39.81 / $40.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $66.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $53.70 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98