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Pennsylvania rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.69 / $52.93 / $68.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.70 / $69.59
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.80 / $23.31 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.29 / $22.29 / $22.29
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.84 / $52.93 / $68.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $22.84 / $68.76
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $21.48 / $21.48
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.52 / $24.52 / $28.45
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.52 / $24.52 / $28.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $39.31