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South Dakota rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.40 / $79.40 / $79.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.28 / $79.40 / $79.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.63 / $14.63 / $18.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.00 / $88.60 / $169.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $70.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.01 / $91.17 / $134.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.27 / $99.92 / $183.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $17.60