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Utah 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
$1,067.11 / $1,067.11 / $1,067.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.55 / $1,067.11 / $1,285.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.83 / $1,092.83 / $1,092.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $1,135.69 / $1,453.68
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.96 / $624.04 / $2,164.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.41 / $1,071.41 / $1,071.41