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Idaho rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $22.62 / $26.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $23.63 / $27.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $21.48 / $21.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.63 / $28.46 / $38.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $26.85
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.71 / $32.45 / $65.90
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.78 / $25.78 / $26.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $28.03