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Maine rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $35.17 / $37.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.15 / $8.07 / $21.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $15.61
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.17 / $35.17 / $37.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $37.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.57 / $12.43 / $18.02