go back

Maine rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $16.60 / $16.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $26.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $8.32 / $20.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $43.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $8.32 / $10.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $8.13 / $26.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $60.26