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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
$21.70 / $23.75 / $49.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.70 / $27.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $22.87 / $38.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.64 / $25.64 / $26.15
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $20.27 / $21.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $44.87