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Virginia rates for HCPCS J0288

Ampho B Cholesteryl Sulfate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.60 / $27.20 / $90.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.60 / $13.60 / $90.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.33 / $103.17 / $105.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.00 / $16.00 / $20.71
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $17.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.74 / $16.00 / $16.80