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South Carolina rates for HCPCS J1451

Fomepizole, 15 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.33 / $12.43 / $50.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $15.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.48 / $15.22 / $26.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.40 / $11.82 / $14.18
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.60 / $13.67 / $16.78
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.42 / $9.42 / $9.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.19 / $13.98 / $18.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.43 / $12.43 / $12.43