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South Carolina rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $3,801.89 / $4,265.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,071.52 / $1,122.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $912.01 / $1,621.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,348.96 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $645.65 / $1,000.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,096.48 / $1,584.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,148.15 / $1,202.26