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Pennsylvania 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
$534.66 / $1,238.75 / $1,609.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $551.76 / $1,365.80
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.78 / $592.67 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.91 / $566.91 / $566.91
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.66 / $903.59 / $1,609.32
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.66 / $606.92 / $1,609.32
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.37 / $546.29 / $546.29
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $546.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.78 / $629.78 / $730.78
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.78 / $629.78 / $730.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $941.53