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South Dakota rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $14.79 / $18.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $89.13 / $169.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $15.85 / $70.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $15.85 / $17.78