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Tennessee rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,067.11 / $1,387.26 / $1,910.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,067.11 / $1,131.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.55 / $1,296.41 / $1,414.26
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,244.38 / $5,678.45 / $5,678.45
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,885.62 / $4,885.62 / $5,785.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.84 / $1,071.41 / $1,199.98