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Wyoming rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.58 / $15.58 / $15.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $15.58 / $16.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.77 / $78.55 / $78.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.17 / $15.17 / $15.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $22.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07