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Minnesota rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.00 / $830.00 / $1,000.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.60 / $1,180.10 / $2,063.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.00 / $820.00 / $820.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.74 / $699.94 / $852.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.95 / $257.83 / $279.08
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.84 / $638.74 / $801.65
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.75 / $219.75 / $298.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.70 / $1,148.42 / $1,690.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $381.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $393.05