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Michigan rates for HCPCS J0740

Injection, cidofovir, 375 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $1,047.13 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $537.03 / $954.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,174.90 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $457.09 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,412.54 / $1,698.24
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $575.44 / $741.31
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $562.34