go back

Fomivirsen Injection

Montana rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Rates data updated July 2026.

How much rates vary

Facilitymedian $89 · 10th to 90th $89 to $107Professionalmedian $89 · 10th to 90th $89 to $107
$100.0facility $89professional $89

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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