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Vermont rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $18.20 / $18.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $60.26