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Louisiana rates for HCPCS J0207

Injection Amifostine 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,285.69 / $1,285.69 / $1,799.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.41 / $1,285.69 / $1,349.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.19 / $286.51 / $1,157.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,099.26 / $1,157.11 / $1,180.26
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.45 / $1,071.41 / $1,285.69