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New Hampshire rates for HCPCS J0740

Injection, cidofovir, 375 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $588.84 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $575.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,380.38 / $2,290.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $933.25 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $794.33