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Rhode Island 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
$4,178.49 / $4,178.49 / $4,178.49
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
$1,092.83 / $1,135.69 / $1,199.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,157.11 / $1,157.11 / $1,157.11
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,192.70