go back

Idaho rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $15.58 / $17.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $17.68 / $20.10
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.75 / $20.10 / $28.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.28 / $17.69 / $20.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.92 / $85.77 / $149.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.29 / $19.29 / $20.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $20.92