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Maryland rates for HCPCS J0740

Injection Cidofovir 375 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.38 / $529.38 / $529.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $709.37
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.37 / $529.37 / $546.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $695.75
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $933.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $579.07
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.10 / $301.10 / $301.10