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North Carolina rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.63 / $15.03 / $15.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.58 / $15.30 / $15.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.14 / $19.14 / $19.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.25 / $11.25 / $13.05
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 / $15.16
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.30 / $16.22 / $16.68
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $7.70 / $7.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $16.16
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00