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North Dakota rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.13 / $23.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $15.16 / $15.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.05 / $13.12 / $13.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.09 / $13.10 / $13.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.75 / $6.82 / $8.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.19 / $18.00 / $20.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $13.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.57 / $12.43 / $13.50