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Fomivirsen Injection

Wisconsin rates for HCPCS J1452

Injection, fomivirsen sodium, intraocular, 1.65 mg

Rates data updated October 2026.

How much does Fomivirsen Injection cost?

$269per 1.65 mg

Typical negotiated rate. In Wisconsin, October 2026.

Insurers have agreed to pay about $269 for each 1.65 mg of this drug. The price depends on where it is billed: about $245 from a physician practice, and about $525 from a hospital or other facility.

Work out the cost of a dose

This drug is priced per 1.65 mg. Enter the amount given to see what insurers have agreed to pay for it.

mg
In a doctor's office or clinic
$245
At a hospital outpatient department
$525

The same drug, in the same amount, costs 114% more at a hospital than at a doctor's office.

Drug cost only. Giving the drug, the visit itself and any monitoring are billed on their own codes. We do not publish dosing guidance: use the amount from your own prescription or treatment plan.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$245$214 to $282
FacilityA hospital or hospital-owned outpatient department$525$525 to $603

How much rates vary

Facilitymedian $525 · 10th to 90th $324 to $794Professionalmedian $245 · 10th to 90th $214 to $295
$200$500$1Kfacility $525professional $245

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
Cigna
Setting
Facility
Modifier
None
Typical Low
$323.59
Median
$524.81
Typical High
$602.56
Cigna
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$257.04
Typical High
$281.84
DeanCare
Setting
Facility
Modifier
None
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
DeanCare
Setting
Professional
Modifier
None
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
Medica
Setting
Facility
Modifier
None
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Medica
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$213.80
Typical High
$295.12
Prevea360
Setting
Facility
Modifier
None
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Prevea360
Setting
Professional
Modifier
None
Typical Low
$489.78
Median
$489.78
Typical High
$489.78

Where Wisconsin sits

The same service costs 31.6 times more in Virginia than in Florida. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Wisconsin· 11th of 26

$269

VA $1,259FL $39.81

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.