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Idaho 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 / $1,105.69
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.13 / $1,105.69 / $1,398.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.23 / $570.72 / $1,135.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,500.00 / $3,900.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.76 / $654.60 / $2,203.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,135.69