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West Virginia rates for HCPCS J0720

Injection, chloramphenicol sodium succinate, up to 1 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.62 / $49.62 / $58.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.46 / $49.62 / $49.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.52 / $20.14 / $35.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.62 / $49.62 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.62 / $49.62 / $74.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.65 / $48.65 / $58.38