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Pennsylvania rates for HCPCS J0287

Injection Amphotericin B Lipid Complex 10 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.30 / $24.10 / $31.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.40 / $24.52
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.49 / $11.17 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.69 / $10.69 / $10.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.72 / $10.30 / $10.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.40 / $24.10 / $31.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.40 / $31.31
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.72 / $10.30 / $10.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $10.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.30 / $10.30 / $11.95
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $11.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $14.22