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Nationwide rates for HCPCS J1452

Injection Fomivirsen Sodium Intraocular 1.65 Mg (Special Coverage Instructions Apply. See Mcm: 2049.3)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.00 / $876.00 / $1,818.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.00 / $830.00 / $850.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.00 / $250.00 / $409.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $216.12 / $336.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.00 / $212.00 / $212.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $212.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $296.80