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Oklahoma rates for HCPCS J1451

Injection, fomepizole, 15 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.30 / $20.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $15.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $8.32 / $13.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $12.88 / $12.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $12.30 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $12.30 / $12.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $6.46 / $6.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $12.30