| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Professional | $199.53 | $213.80 | $323.59 |
Injection, fomivirsen sodium, intraocular, 1.65 mg
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Professional | $199.53 | $213.80 | $323.59 |