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Connecticut rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.00 / $1,276.60 / $2,794.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.00 / $850.00 / $850.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.00 / $212.00 / $233.20
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.00 / $850.00 / $850.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.80 / $212.00 / $920.00