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Louisiana rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $16.36 / $38.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $16.23 / $18.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.79 / $23.79 / $35.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.79 / $23.79 / $24.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.17 / $15.17 / $16.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $33.59