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South Carolina rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.00 / $71.42 / $288.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.78 / $59.78 / $71.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.74 / $24.01 / $42.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.08 / $16.00 / $19.20
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.20 / $71.42 / $96.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.12 / $13.12 / $16.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $17.60