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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
$49.83 / $49.83 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.34 / $27.37 / $27.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.79 / $26.09 / $68.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
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 / $21.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $26.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.83 / $49.83 / $53.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.34 / $27.37 / $53.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $37.59