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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
$20.89 / $41.69 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $40.74
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $22.39 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $21.38 / $21.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $36.31 / $36.31
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $41.69 / $63.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $20.89 / $57.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.47 / $25.12 / $46.77
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $25.12 / $42.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $38.02