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Maryland rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.67 / $80.67 / $90.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.94 / $80.67 / $103.26
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $17.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.36 / $88.66 / $114.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $16.39
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00