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Utah 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 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $47.86 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $52.48 / $52.48
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98