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Rhode Island rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,250.00 / $3,250.00 / $3,250.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.00 / $800.00 / $850.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.71 / $172.71 / $191.90
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $212.00 / $1,000.00