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Washington 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
$495.54 / $869.14 / $1,180.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $600.91 / $782.34
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.73 / $817.10 / $1,579.72
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.55 / $546.29 / $1,037.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.37 / $515.37 / $1,043.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.29 / $546.29 / $669.98
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.37 / $661.73 / $1,136.28
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$471.06 / $886.71 / $1,551.74
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.42 / $326.67 / $1,037.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.73 / $686.11 / $1,212.83
Regence BlueShield
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 / $546.29