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North Dakota rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.07 / $16.07 / $28.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $18.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.44 / $17.53 / $17.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.82 / $17.50 / $17.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.01 / $22.01 / $27.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $24.12 / $78.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $15.58 / $21.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.67 / $16.07 / $47.47