Intraocular fomivirsen eye injection

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Intraocular Fomivirsen na

Payers reporting HCPCS J1452

Payer pricing summary

Low

$85

Average

$742

Median

$536

High

$4.1k

Payer rate distribution

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#
1	Cigna fee schedule · outpatient · +5 other terms	174	$401	$690	$466	68%	—	$193 – $1.8k
2	Aetna fee schedule · outpatient · +8 other terms	104	$1.2k	$1.8k	$1.4k	79%	—	$649 – $8.7k
3	Humana fee schedule · outpatient · +6 other terms	74	$3.5k	$5.2k	$3.4k	66%	—	$682 – $9.7k
4	UnitedHealthcare fee schedule · outpatient · +7 other terms	46	$747	$606	$368	61%	—	$2 – $1.5k
5	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	45	$950	$1.0k	$881	88%	—	$85 – $4.2k
6	Molina facility · case rate · outpatient · +4 other terms	27	$618	$552	$222	40%	—	$288 – $1.1k
7	Anthem facility · fee schedule · outpatient · +5 other terms	20	$840	$694	$328	47%	—	$201 – $1.5k
8	Caresource facility · case rate · outpatient · +1 other terms	16	$684	$733	$160	22%	—	$447 – $1.1k
9	Aetna Better Health fee schedule · outpatient · +2 other terms	13	$824	$876	$56	6%	—	$824 – $936
10	Optum facility · case rate · outpatient · +1 other terms	13	$595	$618	$203	33%	—	$273 – $1.0k
11	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$960	$915	$265	29%	—	$499 – $1.2k
12	Highmark fee schedule · outpatient · +2 other terms	12	$234	$250	$121	48%	—	$213 – $1.4k
13	Medica fee schedule · outpatient · +4 other terms	10	$430	$434	$108	25%	—	$261 – $555
14	Ucare fee schedule · both	9	$210	$211	$5	3%	—	$205 – $216
15	Amerihealth Caritas facility · case rate · outpatient · +1 other terms	7	$317	$321	$10	3%	—	$317 – $345
16	Bcbs La fee schedule · outpatient · +1 other terms	6	$950	$950	—	—	—	$950 – $950
17	First Health facility · fee schedule · outpatient	4	$2.5k	$2.5k	—	—	—	$2.5k – $2.5k
18	Bcbs Id facility · fee schedule · outpatient	3	$273	$242	$92	38%	—	$134 – $350
19	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$1.1k	$1.1k	—	—	—	$1.1k – $1.1k
20	Wellmark facility · case rate · outpatient · +2 other terms	3	$1.2k	$1.0k	$321	32%	—	$473 – $1.3k
21	Bcbs Vt professional · fee schedule · outpatient	2	$605	$622	$139	22%	—	$467 – $850
22	Medicaid facility · case rate · outpatient	2	$288	$288	—	—	—	$288 – $288
23	MultiPlan professional · percent of total billed charges · bothfrom % of charges	2	$211	$211	—	—	—	$211 – $211
24	Bcbs Il professional · fee schedule · both	1	$284	$284	—	—	—	$284 – $284
25	Bcbs Nv fee schedule · outpatient	1	$212	$212	—	—	—	$212 – $212

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