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Washington rates for HCPCS J0740

Injection, cidofovir, 375 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $870.96 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $562.34 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $645.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $676.08 / $1,023.29
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $630.96 / $1,548.82
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $630.96 / $630.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $676.08 / $1,584.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $676.08