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Missouri 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
$1,028.55 / $1,285.69 / $1,529.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,028.55 / $1,285.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.41 / $1,232.11 / $4,079.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.27 / $1,028.55 / $1,285.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,285.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.55 / $1,257.92 / $1,630.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.75 / $1,135.69 / $4,885.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.27 / $1,071.41 / $1,274.98