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Oklahoma rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.08 / $54.08 / $107.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.08 / $54.08 / $54.08
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.35 / $54.08 / $387.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $16.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $17.14