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Alabama 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
$850.00 / $850.00 / $850.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.00 / $850.00 / $1,413.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.39 / $852.39 / $1,146.73
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 / $395.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $212.00