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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
$6.76 / $13.49 / $15.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.76 / $11.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $7.59 / $9.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $7.41 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $8.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $29.51 / $407.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $21.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $19.50 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.76 / $32.36