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Maryland 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 / $1,092.83 / $1,542.83
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.69 / $1,135.69 / $1,135.69
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.66 / $548.57 / $815.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,192.70 / $1,296.41
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.69 / $1,135.69 / $1,135.69