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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
$6.92 / $13.49 / $21.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $18.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $21.88 / $43.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $5.75 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.24 / $21.38 / $72.44
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $7.41 / $20.89
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $21.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $9.12