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Arizona rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.21 / $32.15 / $48.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.14 / $17.68 / $20.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.80 / $70.58 / $330.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.37 / $15.08 / $102.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.17 / $16.07 / $16.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.62 / $20.57 / $86.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $15.58 / $15.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07