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Fomivirsen Injection

Pennsylvania rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Rates data updated October 2026.

How much rates vary

Facilitymedian $871 · 10th to 90th $871 to $871Professionalmedian $871 · 10th to 90th $871 to $871
$1Kfacility $871professional $871

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Geisinger
Setting
Facility
Modifier
None
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,000.00
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$870.96
Median
$870.96
Typical High
$870.96