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Pennsylvania 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 / $75.86 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $48.98 / $57.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $48.98 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98
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
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $74.13 / $128.82
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $48.98 / $70.79
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $47.86 / $57.54
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $42.66 / $57.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $67.61