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Minnesota 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 / $1,285.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,067.11 / $1,285.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,070.97 / $1,410.02 / $2,636.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$874.26 / $1,092.83 / $1,092.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,141.98 / $3,686.03 / $4,487.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,157.25 / $1,261.40 / $1,469.71
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,847.59 / $3,258.82 / $4,043.89
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,157.25 / $1,157.25 / $1,234.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$538.34 / $1,135.69 / $1,135.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,192.70 / $4,885.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,135.69 / $2,313.50