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Washington, DC rates for HCPCS J1451

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
$12.89 / $12.89 / $12.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.86 / $9.86 / $9.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.67 / $16.67 / $16.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.31 / $12.43 / $20.14