go back

Montana rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.46 / $48.46 / $85.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.81 / $36.81 / $66.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.81 / $49.62 / $49.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.81 / $36.81 / $66.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.10 / $49.99 / $76.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.65 / $48.65 / $48.65