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Nebraska rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $23.99 / $34.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $20.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $7.59 / $7.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $7.41 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $8.51 / $12.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $15.14 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $12.30 / $15.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $16.22 / $16.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $6.46 / $12.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $12.30 / $15.85