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Fomivirsen Injection

Wisconsin rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Rates data updated July 2026.

Facilitymedian $525 · 10th–90th $282$8910%10%20%10th90th$525Professionalmedian $219 · 10th–90th $214$3160%20%40%10th90th$219$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Cigna
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$524.81
Typical High
$891.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$245.47
Typical High
$281.84
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
Medica
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Medica
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$338.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$54.95
Typical High
$85.11
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$489.78