go back

Montana rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.42 / $27.37 / $69.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.61 / $26.61 / $78.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $26.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.61 / $26.61 / $78.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $23.31 / $30.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48