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Massachusetts rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $30.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.02 / $22.11 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.75 / $12.43 / $15.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.45 / $18.37 / $39.17
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.18 / $53.00 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $26.77
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $18.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $17.39