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Maine rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.11 / $37.11 / $40.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.36 / $82.36 / $82.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.11 / $37.11 / $40.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $82.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $16.00 / $28.00