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North Dakota 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
$546.29 / $546.29 / $952.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $551.75 / $640.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$592.67 / $595.64 / $603.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.78 / $594.75 / $600.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.67 / $536.99 / $664.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.38 / $577.03 / $1,037.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.83 / $529.38 / $574.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.35 / $546.29 / $593.29