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Arkansas rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,067.11 / $1,092.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,178.55 / $1,178.55 / $1,178.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.55 / $1,178.55 / $1,178.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$481.72 / $1,092.83 / $1,178.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,092.83 / $1,232.11