go back

Pennsylvania rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $15.85 / $20.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $18.62
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $7.24 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $6.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $11.75 / $11.75
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $15.85 / $20.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.76 / $20.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $12.30