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Maine rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,320.00 / $2,320.00 / $2,500.00
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
$198.00 / $212.00 / $212.00
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,320.00 / $2,320.00 / $2,500.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.00 / $850.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $371.00