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Arizona rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.69 / $2,571.38 / $3,857.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,067.11 / $1,249.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$925.70 / $3,413.50 / $6,045.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.98 / $1,028.55 / $1,157.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.19 / $1,067.11 / $2,067.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $4,885.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,135.69