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New Jersey rates for HCPCS J1451

Fomepizole, 15 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.89 / $18.17 / $92.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.46 / $12.58 / $12.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.05 / $15.30 / $19.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.46 / $13.07 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $15.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.16 / $5.16 / $5.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $15.23