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Maine rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.31 / $37.31 / $40.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.72 / $18.85 / $18.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.56 / $19.53 / $50.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $19.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.31 / $37.31 / $40.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.72 / $18.85 / $40.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $22.51 / $59.60