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Louisiana rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $21.88 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $24.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $23.99 / $23.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $24.55
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $19.50 / $20.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $20.89 / $24.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $28.18