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Maryland rates for HCPCS J0289

Amphotericin B Liposome Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $22.62 / $293.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $30.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.49 / $21.49 / $22.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $27.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $56.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $22.77
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.98 / $23.98 / $23.98