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Indiana rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.70 / $55.99 / $102.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.70 / $22.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.48 / $42.96 / $56.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.10 / $6.10 / $21.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.48 / $21.48 / $29.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $26.85
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 / $64.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $42.96