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Kentucky rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.13 / $25.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.58 / $7.90 / $16.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.70 / $10.71 / $10.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.96 / $7.15 / $11.92
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.07 / $5.96 / $9.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.96 / $12.89 / $19.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $12.43 / $12.43