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Louisiana rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.16 / $15.16 / $21.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.16 / $15.16 / $15.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.52 / $12.35 / $14.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $14.40 / $14.69
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $15.73