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Wyoming rates for HCPCS J0289

Injection, amphotericin B liposome, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $35.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $61.66 / $61.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $19.50 / $19.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $29.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $17.78 / $46.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89