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New Hampshire rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.60 / $13.60 / $16.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.60 / $13.60 / $13.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $16.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.92 / $14.21 / $18.09