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Oregon rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $50.12 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $47.86 / $50.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $56.23 / $60.26
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $17.78 / $100.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $19.95 / $66.07
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $41.69 / $41.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $64.57 / $144.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $50.12 / $79.43
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98