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Nebraska rates for HCPCS J0288

Ampho B Cholesteryl Sulfate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.75 / $35.36 / $144.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.76 / $67.76 / $113.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.89 / $15.85 / $15.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.06 / $15.69 / $15.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.63 / $18.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.00 / $128.74 / $387.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $17.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.65 / $89.21 / $134.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.27 / $99.92 / $182.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $16.00 / $16.00