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Illinois rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $11.75 / $17.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $18.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $63.10 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $38.02 / $199.53
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $16.98 / $81.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $35.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $21.88