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Oregon rates for HCPCS J1452

Injection Fomivirsen Sodium Intraocular 1.65 Mg (Special Coverage Instructions Apply. See Mcm: 2049.3)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $2,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.00 / $830.00 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.00 / $424.00 / $424.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $230.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.00 / $1,186.90 / $1,784.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,910.16 / $17,150.38 / $18,772.80
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.00 / $212.00 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.00 / $1,186.90 / $2,400,000.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $230.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $243.80