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North Carolina rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$553.05 / $1,092.83 / $1,364.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,092.83 / $1,092.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,328.55 / $2,324.96 / $3,122.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,109.19 / $1,328.55 / $1,461.41
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 / $1,285.69
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.11 / $899.98 / $1,414.26
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.11 / $421.00 / $1,588.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,135.69 / $1,285.69
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,244.38 / $1,586.26 / $5,678.45
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,885.62 / $4,885.62 / $5,785.61