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Mississippi 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
$1,054.27 / $1,542.83 / $1,542.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,067.11 / $1,542.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.96 / $451.96 / $497.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.48 / $375.48 / $980.14
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,071.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$985.70 / $1,071.41 / $1,414.26