| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $212.00 | $212.00 | $212.00 | |
HMSA
| Professional | $249.74 | $249.74 | $249.74 | |
United
| Professional | $198.43 | $212.00 | $318.00 |
Injection, fomivirsen sodium, intraocular, 1.65 mg
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $212.00 | $212.00 | $212.00 | |
HMSA
| Professional | $249.74 | $249.74 | $249.74 | |
United
| Professional | $198.43 | $212.00 | $318.00 |