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Alabama rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.89 / $21.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.53 / $580.72 / $781.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.48 / $12.89 / $12.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43