go back

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 / $0.22 / $6.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $23.44
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $8.51
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $6.76 / $75.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $21.88
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $38.02