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Montana rates for HCPCS J0287

Injection Amphotericin B Lipid Complex 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.23 / $12.46 / $24.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.76 / $11.76 / $19.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $11.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.76 / $11.76 / $19.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $11.18 / $14.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30