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Illinois rates for HCPCS J1451

Fomepizole, 15 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $22.74 / $40.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $15.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.23 / $34.45 / $142.27
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $100.00 / $345.40
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.30 / $8.53 / $9.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $14.12