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New Mexico rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.10 / $17.10 / $17.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.58 / $12.58 / $17.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.46 / $38.34 / $62.47
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.09 / $7.09 / $7.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $12.89 / $15.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $12.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43