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Wisconsin rates for HCPCS J0289

Amphotericin B Liposome Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.13 / $44.11 / $51.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $22.13 / $69.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.85 / $39.74 / $47.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $27.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.41 / $29.41 / $34.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.48 / $56.65 / $80.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.74 / $41.58 / $47.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.53 / $22.62 / $48.48
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.49 / $42.96 / $42.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.53 / $22.62 / $49.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.62 / $22.62 / $42.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.31 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.53 / $22.62 / $48.48
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.49 / $42.96 / $42.96
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $33.45 / $74.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.80 / $132.80 / $132.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $21.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.62 / $22.62 / $22.62
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.74 / $30.16 / $40.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $34.36