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Utah rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.92 / $24.92 / $26.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.92 / $24.92 / $24.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.05 / $33.27 / $38.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.04 / $46.50 / $62.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.41 / $21.48 / $21.48