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Indiana rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $67.61 / $304.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.80 / $67.61 / $76.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $14.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $14.00 / $18.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.84 / $71.84 / $71.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.84 / $71.84 / $71.84
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 / $38.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $27.20