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Maine rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,982.80 / $2,982.80 / $3,214.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.27 / $1,092.83 / $1,285.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,010.08 / $1,262.55 / $3,599.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,092.83 / $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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.69 / $1,135.69 / $1,135.69
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,982.80 / $2,982.80 / $3,214.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.27 / $1,092.83 / $1,285.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,553.54