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New Hampshire rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $12.89 / $15.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.48 / $20.10 / $30.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.88 / $12.88
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 / $12.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.52 / $20.93 / $39.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $16.82 / $21.42