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Texas rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $16.22 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $10.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $186.21 / $354.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $6.76 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $10.47 / $23.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $69.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $10.00 / $26.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $8.32 / $15.14
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 / $6.76