HCPCS J1452
Injection, fomivirsen sodium, intraocular, 1.65 mg
Retired code16 hospitals with prices
This code is retired. Some hospitals still list it.
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $5,066 | — | — |
| Deaconess Medical Center | $2,210 | — | — |
| Mary Bridge Children's Hospital | $6,562 | — | — |
| MultiCare Auburn Medical Center | $6,129 | — | — |
| MultiCare Covington Medical Center | $6,129 | — | — |
| MultiCare Good Samaritan Hospital | $6,129 | — | — |
| MultiCare Valley Hospital | $2,210 | — | — |
| Overlake Hospital Medical Center & Clinics | $394 – $2,424 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $1,700 | — | — |
| Providence Centralia Hospital | $2,142 | — | — |
| Providence Holy Family Hospital | $1,700 | — | — |
| Providence Regional Medical Center Everett | $1,700 | — | — |
| Providence St Mary Medical Center | $1,700 | — | — |
| Providence St Peter Hospital | $1,768 | — | — |
| Tacoma General Allenmore Hospital | $6,129 | — | — |
| Virginia Mason Medical Center | $663 – $752 | — | — |
Medicare (traditional) reference
CMS publishes no national amount for this code.