Amphotericin B cholesteryl sulfate injection

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Ampho b cholesteryl sulfate

Payers reporting HCPCS J0288

Payer pricing summary

Low

Average

$151

Median

$65

High

$1.0k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +7 other terms	196	$86	$110	$78	71%	—	$14 – $443
2	Cigna fee schedule · outpatient · +5 other terms	179	$26	$59	$110	186%	—	$13 – $1.1k
3	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	129	$32	$50	$125	252%	—	$0 – $1.6k
4	Aetna fee schedule · outpatient · +8 other terms	101	$33	$76	$154	202%	—	$0 – $975
5	Humana fee schedule · outpatient · +6 other terms	76	$75	$67	$39	58%	—	$15 – $193
6	Anthem fee schedule · outpatient · +7 other terms	43	$0	$13	$32	249%	—	$0 – $145
7	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$58	$52	$17	33%	—	$21 – $90
8	Molina facility · case rate · outpatient · +4 other terms	27	$121	$113	$40	35%	—	$65 – $218
9	Caresource facility · case rate · outpatient · +1 other terms	15	$131	$141	$32	23%	—	$87 – $222
10	Optum facility · case rate · outpatient · +2 other terms	13	$116	$122	$37	31%	—	$62 – $197
11	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$18	$17	$5	29%	—	$9 – $22
12	Regence fee schedule · outpatient · +1 other terms	12	$84	$91	$24	26%	—	$65 – $217
13	Medica fee schedule · outpatient · +4 other terms	10	$32	$33	$8	25%	—	$20 – $42
14	Ucare fee schedule · both	9	$14	$14	$0	3%	—	$14 – $14
15	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$74	$74	—	—	—	$74 – $74
16	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$72	$73	$2	3%	—	$72 – $78
17	Bcbs La fee schedule · outpatient · +1 other terms	6	$14	$14	—	—	—	$14 – $14
18	Kaiser fee schedule · outpatient · +2 other terms	6	$442	$561	$598	107%	—	$29 – $1.4k
19	MultiPlan fee schedule · inpatient · +4 other terms	5	$1.6k	$1.4k	$455	32%	—	$742 – $2.0k
20	First Health fee schedule · inpatient · +2 other terms	4	$1.5k	$1.4k	$312	22%	—	$869 – $1.6k
21	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$19	$19	—	—	—	$19 – $19
22	Bcbs Sc fee schedule · outpatient	3	$25	$25	—	—	—	$25 – $25
23	Wellmark facility · case rate · outpatient · +1 other terms	3	$258	$226	$71	32%	—	$105 – $284
24	Bcbs Id facility · fee schedule · outpatient	2	$24	$26	$6	22%	—	$18 – $31
25	Bcbs Vt professional · fee schedule · outpatient	2	$37	$37	$11	30%	—	$14 – $54

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