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Utah rates for HCPCS J1455

Foscarnet Sodium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.07 / $18.64 / $18.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.64 / $18.64 / $18.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.19 / $30.87 / $51.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.41 / $105.39 / $145.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07