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Michigan rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.13 / $37.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.34 / $22.23 / $42.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.26 / $7.64 / $7.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.26 / $12.89 / $12.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $15.16 / $33.75
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $13.18 / $15.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $13.19