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Missouri rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $14.79 / $14.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $141.25 / $389.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $15.85 / $16.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $117.49 / $117.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $15.85 / $16.22