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Hawaii rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.89 / $55.89 / $55.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.68 / $19.29 / $22.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $24.12 / $45.93
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.19 / $15.58 / $49.38