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Rhode Island 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
$1,775.44 / $1,775.44 / $1,775.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $568.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.38 / $529.38 / $881.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $846.00