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Missouri rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $15.14 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $20.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $11.48 / $32.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $15.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $12.88 / $12.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $18.20 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $12.30 / $14.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $7.59 / $19.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $12.30 / $15.14