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Illinois rates for HCPCS J0288

Ampho B Cholesteryl Sulfate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.00 / $71.73 / $237.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.60 / $70.39 / $76.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.80 / $48.62 / $199.58
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.08 / $49.90 / $120.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.26 / $12.26 / $12.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $16.98