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Massachusetts rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.00 / $850.00 / $2,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.00 / $850.00 / $850.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.00 / $850.00 / $850.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $850.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.48 / $270.51 / $576.64
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.00 / $850.00 / $850.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $850.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $850.00