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Georgia rates for HCPCS J1451

Fomepizole, 15 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.58 / $12.58 / $12.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.58 / $14.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.70 / $12.43 / $24.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $14.29 / $14.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $13.27 / $26.00
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.92 / $14.62 / $14.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $15.73