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Ohio rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $30.32 / $38.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $12.13 / $33.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.24 / $12.02 / $29.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.70 / $8.10 / $19.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.19 / $6.19 / $10.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.19 / $6.19 / $6.19
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 / $20.28
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.89 / $12.89 / $20.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.37 / $8.37 / $9.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $13.54