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Nebraska rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $22.62 / $47.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $22.62 / $69.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.23 / $23.10 / $24.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.10 / $24.32 / $25.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.00 / $32.00 / $32.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $23.74 / $29.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $26.66 / $132.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $22.62 / $33.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.14 / $35.97 / $55.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.70 / $27.97 / $68.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $21.48 / $23.63