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New Hampshire rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.48 / $22.62 / $27.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $22.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.60 / $38.65 / $97.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $22.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $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
$22.54 / $34.88 / $66.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.43 / $33.47 / $42.60