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Nebraska rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.00 / $1,922.10 / $2,210.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.00 / $800.00 / $1,342.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.01 / $240.01 / $240.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.00 / $237.61 / $240.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $219.75 / $274.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,520.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $318.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.17 / $660.17 / $1,539.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.17 / $1,539.54 / $1,539.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.40 / $212.00 / $318.00