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Illinois rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $37.59 / $75.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $22.13 / $27.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.60 / $89.31 / $501.49
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $38.88 / $147.24
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.92 / $27.92 / $27.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $38.65