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Montana rates for HCPCS J0740

Injection, cidofovir, 375 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.75 / $606.92 / $1,745.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.20 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.66 / $595.66 / $1,740.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $595.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.66 / $595.66 / $1,740.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $592.67 / $773.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $546.29