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Kansas rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $15.16 / $15.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $15.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.04 / $14.96 / $17.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $12.21 / $18.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $15.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $15.73