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Wisconsin rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $524.81 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $245.47 / $281.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $338.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $338.84