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Arizona rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.37 / $43.60 / $2,340.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $27.37 / $69.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.05 / $77.78 / $132.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.05 / $21.90 / $136.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.41 / $35.58 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.62 / $22.62 / $22.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48