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Indiana rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $19.05 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $7.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $10.00 / $15.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $12.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $23.99 / $32.36
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 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $21.88