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West Virginia rates for HCPCS J0207

Injection, amifostine, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,071.52 / $1,122.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,041.74 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $5,754.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,148.15 / $1,288.25