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West Virginia 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 / $16.00 / $55.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.28 / $90.09 / $90.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.06 / $63.05 / $110.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $14.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $341.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.52 / $16.00 / $16.00