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Oklahoma rates for HCPCS J0289

Amphotericin B Liposome Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $24.43 / $41.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.20 / $23.20 / $23.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.08 / $20.63 / $32.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $20.27 / $21.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.02 / $21.48 / $21.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.62 / $26.09 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $22.62 / $23.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48