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Idaho 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
$12.13 / $12.89 / $13.04
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $13.82 / $18.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.10 / $15.79 / $15.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.91 / $9.86 / $16.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.05 / $10.05 / $12.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.91