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Fomivirsen Injection

Nationwide rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Rates data updated October 2026.

How much does Fomivirsen Injection cost?

$224per 1.65 mg

Typical negotiated rate. Nationwide, October 2026.

Insurers have agreed to pay about $224 for each 1.65 mg of this drug. The price depends on where it is billed: about $219 from a physician practice, and about $692 from a hospital or other facility.

Work out the cost of a dose

This drug is priced per 1.65 mg. Enter the amount given to see what insurers have agreed to pay for it.

mg
In a doctor's office or clinic
$219
At a hospital outpatient department
$692

The same drug, in the same amount, costs 216% more at a hospital than at a doctor's office.

Drug cost only. Giving the drug, the visit itself and any monitoring are billed on their own codes. We do not publish dosing guidance: use the amount from your own prescription or treatment plan.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 19 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$219$214 to $275
FacilityA hospital or hospital-owned outpatient department$692$219 to $977

How much rates vary

Facilitymedian $692 · 10th to 90th $214 to $1,349Professionalmedian $219 · 10th to 90th $214 to $661
$50$100$200$500$1K$2Kfacility $692professional $219

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
BCBS Arkansas
Setting
Facility
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
BCBS Arkansas
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$758.58
Typical High
$2,511.89
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$812.83
Median
$1,230.27
Typical High
$1,348.96
Cigna
Setting
Facility
Modifier
None
Typical Low
$281.84
Median
$575.44
Typical High
$794.33
Cigna
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$245.47
Typical High
$281.84
DeanCare
Setting
Facility
Modifier
None
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
DeanCare
Setting
Professional
Modifier
None
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
Geisinger
Setting
Facility
Modifier
None
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,000.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$323.59
Typical High
$1,412.54
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Health Partners
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$549.54
Typical High
$831.76
Health Partners
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$891.25
Median
$891.25
Typical High
$891.25
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
Medcost
Setting
Professional
Modifier
None
Typical Low
$1,258.93
Median
$1,258.93
Typical High
$1,258.93
Medcost
Setting
Professional
Modifier
None
Typical Low
$954.99
Median
$1,047.13
Typical High
$1,047.13
Medica
Setting
Facility
Modifier
None
Typical Low
$794.33
Median
$977.24
Typical High
$1,513.56
Medica
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$213.80
Typical High
$288.40
Medical Mutual of Ohio
Setting
Professional
Modifier
None
Typical Low
$891.25
Median
$891.25
Typical High
$891.25
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$912.01
Median
$2,089.30
Typical High
$2,290.87
Prevea360
Setting
Facility
Modifier
None
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Prevea360
Setting
Professional
Modifier
None
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
United
Setting
Professional
Modifier
None
Typical Low
$34.67
Median
$54.95
Typical High
$213.80
Univera
Setting
Facility
Modifier
None
Typical Low
$724.44
Median
$851.14
Typical High
$851.14
Univera
Setting
Professional
Modifier
None
Typical Low
$724.44
Median
$851.14
Typical High
$851.14

What it costs in each state

The same service costs 31.6 times more in Virginia than in Florida. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Touch or drag across the chart to see any state's rate.

VA $1,259FL $39.81

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.