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Oklahoma rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $7.24 / $12.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $8.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $39.81 / $64.57
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 / $10.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $17.78 / $95.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $21.88
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 / $21.88