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South Carolina 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 / $1,054.27 / $4,262.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,067.11 / $1,092.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.23 / $909.99 / $1,519.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,285.69 / $1,607.11
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.11 / $612.73 / $1,461.06
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.75 / $499.00 / $1,987.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.27 / $1,054.27 / $1,317.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.70 / $1,135.69 / $1,242.83