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Fomivirsen Injection

Illinois rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Rates data updated July 2026.

Facilitymedian $759 · 10th–90th $427$3,0200%5%10%10th90th$759Professionalmedian $347 · 10th–90th $120$1,4130%20%10th90th$347$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
BCBS
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$758.58
Typical High
$3,019.95
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$346.74
Typical High
$2,137.96
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80