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Arkansas rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.78 / $25.78 / $38.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $25.78 / $27.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.54 / $24.54 / $24.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.19 / $24.54 / $24.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $21.48 / $23.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $53.72