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Mississippi rates for HCPCS J1452

Injection Fomivirsen Sodium Intraocular 1.65 Mg (Special Coverage Instructions Apply. See Mcm: 2049.3)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.00 / $1,200.00 / $1,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.00 / $850.00 / $1,200.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.00 / $212.00 / $233.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $212.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $20.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.52 / $212.00 / $275.60