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North Dakota rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.48 / $21.48 / $40.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $27.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.31 / $23.43 / $23.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.80 / $23.39 / $23.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.74 / $23.74 / $29.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $27.92 / $61.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.62 / $22.62 / $25.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.26 / $21.48 / $23.33