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Pennsylvania rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.08 / $76.81 / $168.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.60 / $60.49 / $69.77
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.35 / $14.53 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $14.53 / $14.53
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.49 / $90.74 / $173.03
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.27 / $60.49 / $138.84
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.20 / $16.00 / $22.10