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Ohio 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 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $14.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.24 / $14.45 / $43.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $7.59 / $12.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $6.31 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $95.50
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $6.31 / $6.76
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $95.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $9.77 / $22.39
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $14.13 / $19.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $12.88