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Maine rates for HCPCS J0287

Injection Amphotericin B Lipid Complex 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.90 / $23.90 / $25.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.71 / $12.46 / $12.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.97 / $12.51 / $32.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $12.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.90 / $23.90 / $25.75
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.71 / $12.46 / $25.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $15.45