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Arizona rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $30.32 / $45.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.28 / $12.28 / $14.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.59 / $44.35 / $71.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.34 / $12.13 / $80.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.28 / $16.53 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43