go back

Utah 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
$80.19 / $633.70 / $1,601.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.70 / $633.70 / $954.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.23 / $457.34 / $810.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $546.29
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.46 / $1,110.98 / $1,579.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $546.29