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Michigan rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.05 / $16.55 / $50.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.05 / $16.55 / $18.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.87 / $35.79 / $67.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.01 / $13.70 / $13.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.46 / $16.07 / $80.37
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.07 / $28.09 / $72.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.05 / $16.07 / $19.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $17.05