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Minnesota rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.16 / $15.16 / $15.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.58 / $15.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.44 / $15.73 / $26.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.31 / $12.89 / $15.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $21.50 / $26.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.82 / $7.92 / $8.57
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.78 / $19.62 / $24.62
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.75 / $6.75 / $9.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $8.75 / $20.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $17.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $22.53