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Rhode Island rates for HCPCS J0720

Injection Chloramphenicol Sodium Succinate Up To 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.74 / $189.74 / $189.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.70 / $46.70 / $49.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.62 / $51.57 / $54.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.54 / $52.54 / $52.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.62 / $49.62 / $49.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.62 / $49.62 / $49.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.60 / $48.65 / $48.65