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New Hampshire rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $54.95 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $48.98 / $50.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $131.83 / $218.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $50.12 / $56.23
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 / $83.18 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $77.62