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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
$6.76 / $6.76 / $6.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $11.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $79.43 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $6.31 / $6.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $9.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76