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Missouri rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $851.14 / $2,344.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $213.80 / $257.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $213.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $257.04