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South Carolina rates for HCPCS J0289

Amphotericin B Liposome Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.56 / $22.56 / $96.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.56 / $26.85 / $36.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.78 / $61.27 / $102.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.34 / $49.42 / $61.33
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.68 / $24.82 / $61.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.57 / $51.57 / $51.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48