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Utah rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $7.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $30.90 / $51.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $147.91 / $213.80
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $8.71 / $102.33
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $16.22 / $16.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76