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New Hampshire 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 / $592.91 / $1,058.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.28 / $546.29 / $546.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$651.12 / $983.32 / $2,478.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.38 / $546.29 / $546.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.37 / $546.29 / $546.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $546.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.16 / $887.18 / $1,686.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $546.29
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.65 / $969.82 / $1,234.31