go back

New York rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.00 / $800.00 / $1,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.00 / $800.00 / $850.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.50 / $225.00 / $347.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.00 / $212.00 / $212.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $212.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $900.00 / $1,458.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.00 / $1,050.00 / $1,060.00
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.00 / $555.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $212.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $394.93
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$850.00 / $850.00 / $850.00
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.00 / $850.00 / $850.00