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Indiana rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $29.83 / $54.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.70 / $14.29 / $32.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.70 / $6.70 / $10.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.26 / $6.26 / $8.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.11 / $6.26 / $10.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.70 / $12.89 / $35.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $15.54