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Montana rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,067.11 / $2,975.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$689.32 / $689.32 / $1,930.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.32 / $1,092.83 / $1,232.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.58 / $713.74 / $1,339.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.23 / $1,285.69 / $1,339.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,071.41