go back

New Hampshire rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $17.45 / $31.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.17 / $28.94 / $72.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $16.07 / $16.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.17 / $16.07 / $16.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.87 / $26.11 / $49.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $60.79
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.37 / $88.41 / $112.52