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Ohio rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.55 / $2,661.38 / $3,772.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,049.11 / $1,316.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.11 / $2,013.58 / $3,257.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,271.97 / $1,873.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.32 / $386.32 / $637.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.32 / $386.32 / $386.32
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
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,285.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.69 / $1,306.04 / $1,637.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.36 / $1,071.41 / $1,285.69