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Fomivirsen Injection

Montana rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Rates data updated July 2026.

Facilitymedian $89 · 10th–90th $89$1070%20%40%90th$89Professionalmedian $89 · 10th–90th $89$1070%20%40%90th$89$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$107.15
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$107.15