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West Virginia rates for HCPCS J0289

Amphotericin B Liposome Inj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.70 / $22.62 / $22.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $22.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.48 / $32.22 / $32.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.27 / $21.48 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $43.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.48 / $21.48 / $63.20