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Iowa rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.00 / $1,922.10 / $2,973.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.00 / $800.00 / $800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.75 / $274.69 / $274.69
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $326.58 / $371.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $660.17 / $1,432.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $369.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.00 / $660.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.17 / $1,539.54 / $1,539.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $224.91