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Arizona rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.12 / $32.00 / $105.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.00 / $75.16 / $90.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.28 / $82.68 / $140.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $16.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $16.00