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North Carolina rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.07 / $66.77 / $80.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $80.37 / $80.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.17 / $28.30 / $31.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $16.17
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 / $78.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.14 / $80.37 / $86.41
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.10 / $10.10 / $10.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $24.92
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.40 / $100.00 / $411.35