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Tennessee rates for HCPCS J0288

Injection, amphotericin B cholesteryl sulfate complex, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.90 / $88.24 / $134.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.88 / $68.59 / $76.14
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.72 / $401.76 / $401.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.60 / $16.00 / $16.00