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Maine rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $20.89 / $40.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $23.99 / $66.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $22.91 / $27.54
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $47.86 / $51.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $25.12 / $61.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $36.31