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South Carolina rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $30.20 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $20.89 / $33.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $58.88 / $109.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $41.69 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $20.89 / $20.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.62 / $29.51 / $67.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $23.44 / $44.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $23.44