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Connecticut rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $19.36 / $42.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.93 / $18.89 / $38.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.88
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.19 / $12.43 / $14.47