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Maryland rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.22 / $15.58 / $15.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $20.88
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.60 / $57.60 / $57.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $20.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $76.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $17.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.28 / $38.28 / $38.28