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North Dakota rates for HCPCS J0288

Ampho B Cholesteryl Sulfate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.23 / $63.23 / $127.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.23 / $79.40 / $79.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.63 / $14.63 / $18.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.00 / $63.23 / $189.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $17.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.60 / $16.00 / $17.38