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Pennsylvania rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.05 / $36.46 / $47.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.23 / $19.32
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.82 / $17.44 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.68 / $16.68 / $16.68
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.74 / $36.46 / $47.36
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.74 / $16.23 / $47.36
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.17 / $16.07 / $16.07
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $29.43