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Ohio rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$800.00 / $1,850.00 / $2,530.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.00 / $800.00 / $2,224.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $217.59 / $336.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59,702.01 / $59,702.01 / $59,702.01
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 / $1,337.36
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $1,337.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $294.91