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Nebraska rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $30.91 / $35.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $26.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.65 / $17.29 / $18.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.76 / $17.64 / $18.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $22.01 / $27.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $29.60 / $411.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $15.58 / $21.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.04 / $45.93 / $115.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $27.09 / $57.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.28 / $16.07 / $17.69