go back

Maryland rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $16.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.86 / $9.86 / $9.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.32 / $10.55 / $14.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $15.73
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.65 / $7.65 / $7.65